A dual wire approach to severe ostial bifurcating renal artery stenosis

Lorin, Jeffrey D.; Hirsh, David S.; Attubato, Michael; Sedlis, Steven P.

doi:10.1002/ccd.20723

Cited by 8 publications

(9 citation statements)

References 39 publications

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“…Atherosclerotic lesions are primarily ostial or proximal in location. ARAS is a progressive disease that may occur alone or in combination with hypertension and ischemic heart disease, unlike in our patient [8]. Atherosclerotic lesions respond poorly to balloon angioplasty alone with significant residual stenosis and restenosis.…”

Section: Discussionmentioning

confidence: 89%

Kissing stent management of stenosis of two branches of left renal artery bifurcation: a case report

et al. 2019

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Background Secondary hypertension accounts for 5% of all cases of hypertension. Renal artery stenosis is one of the common causes of secondary hypertension. Atherosclerosis and fibromuscular dysplasia are the commonest types of stenosis associated with renal vascular hypertension, with the former accounting for 70–80% of all cases and the latter accounting for 10% of the incidence. The greatest incidence atherosclerosis is in men over the age of 40 years, mostly affecting the proximal part of the renal arteries, whereas fibromuscular dysplasia affects women ranging in age from 30 to 50 years. Currently, possible treatments are medical treatment using blood pressure-lowering drugs, balloon angioplasty with or without stent insertion, and surgery to reconstruct the artery. Case presentation We report a case of a 46-year-old Asian woman with stenosis of two branches of renal artery bifurcation treated by percutaneous balloon dilatation and stenting of both branches after referral to our department for a renal angiogram following 8 months of uncontrolled hypertension despite receiving medications. Initially, the patient presented with severe headache and fatigue. She was a known nonsmoker, was not diabetic, and had no history of diabetes in her family. She had no history of atherosclerosis. Apart from high blood pressure, the result of her physical examination was unremarkable. Laboratory investigations revealed normal serum cholesterol, lipid profile, and serum creatinine. She had been attending a hypertension clinic and receiving antihypertensive drugs for the past 8 months on a regular basis under close observation. Despite this treatment and care, her blood pressure remained high at 175/110 mmHg, which the attending doctor concluded to be uncontrolled blood pressure. Initial imaging indicated left renal artery stenosis, and the patient was referred to our department. Conclusions For patients with uncontrolled hypertension despite receiving medications, renal Doppler ultrasound should be included in the diagnostic workup for secondary hypertension. Once renal artery stenosis is suspected, renal angiography is highly recommended because the technique is able to accurately diagnose stenosis in the branch arteries, unlike computed tomographic angiography and magnetic resonance angiography. Percutaneous transluminal renal angioplasty is the treatment of choice for renal artery stenosis in patients with renovascular hypertension or renal dysfunction.

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Section: Discussionmentioning

confidence: 89%

Kissing stent management of stenosis of two branches of left renal artery bifurcation: a case report

et al. 2019

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“…These lesions are often eccentric, elastic, and respond poorly to balloon angioplasty alone with significant residual stenosis and restenosis. Stent placement in this context has been shown to improve immediate and long-term outcome [1, 3, 4]. …”

Section: Discussionmentioning

confidence: 99%

“…Severe renal artery lesions, especially ostial ones, have been proved to be effectively managed by percutaneous intervention with balloon expandable stents, resulting in enhancement of the renal blood flow and control of blood pressure [1]. Approach to revascularization is complicated when renal artery bifurcation is involved, since there is a possibility of creating a total side-branch occlusion during balloon expansion [2].…”

Section: Introductionmentioning

confidence: 99%

Stents in Renal Artery Bifurcation Stenosis: A Case Report

Leonardou

Pappas

2011

Case Reports in Medicine

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A 39-year-old patient presented with poorly controlled hypertension, and she was referred to renal angiogram and potential renal angioplasty. Renal angiogram showed a bifurcation lesion of the right renal artery. A guide wire was used to cross the upper branch, while the lower branch was protected by another same-type guide wire through the same introducer. Two thin monorail balloons were used to dilate the two branches; however, despite balloon dilatation, the stenosis of the vessels persisted. The “kissing balloon” technique was then attempted by simultaneously inflating both branches using the same balloons, but more than a 70% residual stenosis persisted in each branch. Two stents were finally placed in a “kissing” way through the main renal artery. The imaging and clinical results were good, without any procedure-related complications. Three years clinical followup was also good, without any reason for further interventional approach.

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“…The current study is the first report of a large series of patients with bifurcating stents placed in the proximal and lobar pulmonary arteries. Transcatheter placement of bifurcating or “crossing” stents has been well described for treatment of bifurcation stenoses involving the coronary, renal, and iliac arteries [1–4]. However, to our knowledge there is only one case report with 1 year follow up in a patient with bifurcation stenoses of the branch pulmonary arteries [5].…”

Section: Discussionmentioning

confidence: 99%

“…Standard balloon angioplasty alone is often inadequate, and placement of stents is frequently required to provide relief of obstruction. The technique of simultaneous stent placement to treat bifurcating stenoses has been well described in the treatment of lesions in the coronary, renal, and aortoiliac arteries [1–4]. McMahon et al [5] described this technique in the PAs, but there is scant long‐term follow up data reported to date.…”

Section: Introductionmentioning

confidence: 99%