Both Renal Artery Stenosis Treated with Stenting

- Operator : Seung-Jung Park

Both Renal Artery Stenosis Treated with Stenting
- Operator: Seung-Jung Park, MD
Case Presnetation
A 65-year old man was admitted due to exertional chest pain for 6 months. His risk factors were hypertension and diabetes mellitus. The hypertension has not been treated well despite anti-hypertension combination therapy with beta-blocker, calcium channel blocker, diuretics, and ACE inhibitor. His thallium SPECT showed reversible medium-sized moderate perfusion defect in the postero-lateral wall and the echocardiogram showed concentric LV hypertrophy and normal wall motion. The coronary angiogram showed diffuse three vessel disease and the renal angiogram showed 80% discrete ostial stenosis of both renal arteries (Figure 1). His creatinine was 1.4mg/dL. We planned angioplasty with stenting at both renal ateries prior to coronary artery bypass surgery.
Interventional Procedure
An 8Fr RDC catheter was positioned at the left renal artery (Figure 2) and the lesion was predilated with Powerflex balloon(4.0/20mm) at 10atm(4.0mm) (Figure 3). The following angiogram showed significant residual stenosis (Figure 4) and a Renal Palmaz Genesis Stent(6.0/15mm) was deployed at 14atm(6.4mm) (Figure 5, Figure 6, Figure 7). Then the catheter was engaged into right renal artery and predilation was performed with the stent balloon (6.0/15mm) at 6 atm(5.38mm) (Figure 8). Following angiogram showed renal artery dissection (Figure 9) and another Renal Palmaz Genesis Stent(6.0/18mm) was deployed at 12atm(6.2mm) (Figure 10, Figure 11, Figure 12). The final angiogram showed no residual narrowing at both renal artery ostium (Figure 7, Figure 12).

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