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Home > Medical Professionals > Full Index of Images In Vascular Disease > Renal Stenosis PTA

Endoluminal Therapy for Renal Artery Ostial Stenosis

Scott M. Surowiec M.D. and Mark G. Davies, M.D., Ph.D.

A 61 yr old female presented with poorly controlled hypertension (184/100; on four antihypertensive medications; serum creatinine of 0.7mg/dl).  She has no significant coronary artery disease. She is not a diabetic and has a normal lipid profile.  She had an abdominal bruit. 

 

Duplex imaging revealed a proximal right renal artery stenosis with no significant contralateral disease (Figure 1).   Renal dimensions were 9.6cm on the right and 9.3cm on the left.  The patient underwent an arteriogram, which demonstrated a pre-occlusive stenosis at the ostium of the right renal artery, and no significant left renal artery disease (Figure 2). 

 

Figure 1. Duplex ultrasound of proximal right renal artery  showing elevated peak-systolic and end-diastolic velocities.

 

Figure 2. Aortogram showing proximal right renal artery stenosis.

 

The right renal artery was successfully cannulated and the lesion was predilated with a 4-mm balloon.  300µg of nitroglycerin were administered intra-arterially.  A 6 x14mm Nitinol stent was successfully deployed without event (Figure 3). 

 

Figure 3.  Successful deployment of 6 mm by 14 mm nitinol stent in proximal right renal artery.

 

The patient made an uneventful recovery. At one month the patient had a blood pressure 0f 150/70 on two antihypertensive medications and a patent stent on duplex imaging (Figure 4).   Serial duplex imaging for the succeeding 12 months have shown no restenosis and her blood pressure control has remained stable.

 

Figure 4. Follow-up duplex ultrasound of proximal right renal artery showing stent (arrow) and return to normal velocities.