Slides Endovascular Renal
A CHF Patient Properly Managed by Virtue of PCI & Bilateral Renal Arteries Stenting
- Operator :
| A CHF Patient Properly Managed by Virtue of PCI & Bilateral Renal Arteries Stenting |
| - Operator: Woo-Young Chung, MD |
| Clinical presentation |
| The patient was presented with recently aggravated dyspnea on exertion. He had the history of PCI due to AMI and right upper lobectomy due to lung cancer. His coronary risk factors were hypertension and dyslipidemia. Chest X-ray had not any active lung lesion. Echocardiography showed severe hypokinesia of anterior and anteroseptal wall with moderate LV dysfunction (EF=44%). Laboratory finding showed azotemia (serum creatinine 2.0mg/dL) and NT-proBNP elevation (12248pg/mL). |
| Baseline coronary angiogram |
| 1. Left coronary angiogram showed tubular 80-90%
narrowing at mid LAD and tubular 50-60% narrowing at proximal LCX with patent
previous distal LCX stent (Figure
1, Figure
2). 2. Right coronary angiogram showed diffuse 40-50% narrowing at proximal RCA (Figure 3). 3. Abdominal aortography showed bilateral 80-90% narrowing of renal arteries (Figure 4). |
| Procedure |
| A 7F sheath was inserted through the right femoral
artery, and the left coronary ostium was engaged with a 7F, JL 4 catheter.
The LAD was wired with a 0.014 inch Floppy wire. And then predilation of
mid LAD was achieved with Ryujin balloon (2.5mm × 12mm) (Figure
5, Figure
6). A Taxus stent (3.0mm x 16mm) was deployed at the mid LAD (Figure
7, Figure
8). Final coronary angiogram showed well-expanded stent without residual
narrowing (Figure
9). 2 days later, renal angioplasty was done. A 8F sheath was inserted through the left femoral artery, and the renal artery ostium was engaged with a 8F, RDC catheter (Figure 10, Figure 11). The both renal arteries were wired with a 0.35 Exchange wire. Predilatation was performed with a Ultra balloon (5.0mm x 20mm) at proximal left renal artery (Figure 12). Then a Express stent (6.0mm x 27mm)was implanted left renal artery (Figure 13, Figure 14) and additional balloon with a Ultra balloon (6.0mm x 20mm) (Figure 15). The right renal artery lesion was treated a Genesis stent (7.0mm x 24mm) implantation (Figure 16, Figure 17, Figure 18, Figure 19). Final angiogram showed good result (Figure 20, Figure 21). |
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