Stenting of a renal artery bifurcation stenosis

Simultaneous Kissing Balloon Stenting Technique in Management of Two Branches of Right Renal Artery Bifurcation: A Case Report

Atherosclerosis and fibromuscular dysplasia are the commonest types of diseases associated with renovascular hypertension, with atherosclerosis accounting for 70%-80% of all cases and the latter accounting for 10% of cases. We report a case of a 65-year-old asian male with stenosis of the right renal artery with early bifurcation treated by percutaneous balloon dilation and simultaneous kissing balloon stenting technique.

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

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.

Stents in renal artery bifurcation stenosis: a case report

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.

Use of kissing embolic protection devices in the treatment of early bifurcation renal artery stenosis: a case report

Renal artery stenosis (RAS) is a progressive disease that may cause hypertension and chronic renal insufficiency. Percutaneous renal artery angioplasty with stent placement is a well-recognized treatment for atherosclerotic RAS. It can infrequently involve the bifurcation, and treatment of this stenosis has been described using bare metal and drug-eluting stents deployed simultaneously in a kissing fashion. Atheroembolism is believed to be caused by the release of microscopic plaque fragments and cholesterol crystals from the RAS or atherosclerotic aorta. Herein, the authors describe the use of a kissing embolic protection device technique during renal artery stent placement.

A dual wire approach to severe ostial bifurcating renal artery stenosis

Percutaneous intervention with balloon expandable stents has proven to be an effective measure to enhance renal blood flow and control blood pressure in subjects with severe ostial renal artery lesions. A small cohort of these subjects have an ostial bifurcation, which complicates the approach to revascularization. In these cases there is a concern of creating a total side-branch occlusion during balloon expansion. We report two cases of an ostial lesion at a renal artery bifurcation revascularized by employing a sequential dilatation double guidewire technique. Using a single 7F sheath in each case, both renal artery branches were wired, and each branch was predilated and stented in a sequential fashion. Excellent angiographic results were obtained in both cases.

Kissing Balloon Technique for Angioplasty of Renal Artery Bifurcation Stenoses

This study evaluates long-term results after using the kissing balloon technique in percutaneous transluminal angioplasty of bifurcation stenoses of the renal artery. Eight patients with proven renal artery stenosis and deterioration of renal function were treated, including one kidney transplant recipient. Follow-up ranged between 3 and 131 months. All interventions were technically successful. All patients improved in one or more of the following: serum creatinine levels and creatinine clearance, blood pressure, and need for antihypertensive medication. The kissing balloon technique is a reliable and safe method for treating bifurcation stenoses of the renal artery, rendering stable long-term results.