Renal artery stent fracture with refractory hypertension: A case report and review of the literature

Abstract

A 73-year-old man with resistant hypertension and impaired renal function underwent stenting for right renal artery (RRA) stenosis. Two years later, he presented with uncontrolled hypertension and worse renal function. Renal arteriogram revealed RRA stent fracture with in-stent restenosis. Another stent was deployed. Four months later, however, renal arteriogram revealed in-stent restenosis again. This time, balloon angioplasty alone was performed. He had been symptom-free with stable condition at 2-year follow-up. A literature review disclosed six renal artery stent fracture cases, including the present one, who developed in-stent stenosis resulted from stent fracture. Two major anatomy features of renal artery stenosis were suggestive for development of stent fracture: (1) renal artery entrapment by diaphragmatic crus, and (2) mobile kidney with acute angulation at proximal segment of the renal artery. It is important to detect this etiology of renal artery stenosis because stenting in these vessels may contribute to in-stent restenosis or stent fracture. Management of renal artery stent fracture, including endovascular treatment or aortorenal bypass, should be considered on a case-by-case basis in relation to clinical settings.

Treatment of a recurrent renal artery stenosis and stent fracture using a drug eluting stent in a pediatric patient

“…In cases, angioplasty had been reported as very useful, but other authors have reported poor long-term results needing the use of stents [1,[10][11][12][13][14][15]. In our patient, the angioplasties performed obtained an excellent immediate result, but really poor intermediate or long-term results.…”

“…Fracture of stents have been reported by other authors as well, [14,15] although there have been only a few reports of stent fractures in the renal arteries. Chua and Hung [15] suggested as the renal artery entrapment by the diaphragmatic crus, and a mobile kidney with an acute angulation at the proximal segment of the renal artery, as the 2 possible reasons for stent fracture. The reason mentioned by Guzzetta and his co-workers, [16] also dealt with the motion of the renal artery.…”

Left main renal artery entrapment by diaphragmatic crura: spiral CT angiography

“…This bending may lead to stent fracture and restenosis [14]. An alternative is to treat with balloon angioplasty and cutting balloon angioplasty, which may have lower patency rate but fewer stent-related complications in these patients [15]. …”

Laparoscopic treatment of renal artery entrapment

“…[10][11][12] Not surprisingly, balloon angioplasty failed in these cases due to elastic recoil, and stenting failed due to bending and fracture of the implanted stent. [9][10][11]13 Since renal artery entrapment has an extrinsic etiology, we strongly suggest to also treat it from outside of the renal artery.…”