Endovascular Therapy Using Diluted Contrast Medium for Critical Limb Ischemia in a Patient with Chronic Kidney Disease

Ultra-Low-Dose Contrast Using Transluminal Renal Angioplasty: The ULTRA Study

BACKGROUND

Although severe atherosclerotic renal artery stenosis (ARAS) is a predictor of future cardiovascular events, large trials have not shown the benefits of percutaneous transluminal renal angioplasty (PTRA). This study aimed to validate the safety and efficacy of PTRA using low-concentration digital subtraction angiography (LC-DSA) in patients with severe ARAS and advanced chronic kidney disease (CKD).

MATERIALS AND METHODS

This prospective study was conducted between August 2018 and October 2021. Eighteen patients with 20 lesions, CKD stage 3b or worse, and significant renal artery stenosis were included and underwent PTRA using ultra-low-dose contrast medium. The primary endpoint was a change in renal function based on serum creatinine (sCr) level.

RESULTS

The mean sCr level significantly improved from 3.34 ± 1.8 mg/dL pre-PTRA to 2.48 ± 1.19 mg/dL at 1 month post-PTRA (P = .02). The mean amount of contrast used was 8.3 ± 3.9 mL per vessel. More severe stenosis and rapid deterioration of renal function before treatment were associated with improved kidney function. No cardiovascular or renal complications such as stroke or contrast-induced nephropathy were observed during the 30-day period.

CONCLUSIONS

PTRA using an ultra-low-dose contrast medium is safe and provides acceptable results.

Successful Retrieval of a Stuck Guidewire by Guiding Catheter Lock Technique in Renal Artery Stenting

Introduction

The guiding catheter lock technique is a therapeutic technique to increase backup force of the guiding catheter in coronary artery interventions.

Surgical technique

A 71 year old man presented with rapidly declining kidney function resulting from bilateral renal artery stenosis. During the renal artery stenting procedure, the 0.014" guidewire became trapped at the stent's distal edge. Although attempts were made to advance a microcatheter and balloon catheter over the trapped guidewire, these failed because of insufficient pushability of the guiding catheter. Therefore, the guiding catheter lock technique was used with a second guiding catheter, and the guidewire was successfully retrieved.

Discussion

The guiding catheter lock technique facilitated strong pushability to allow for successful retrieval of a stuck guidewire during renal artery stenting.

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During renal artery stenting, a guidewire was trapped at the stent's distal edge.

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The stuck guidewire was retrieved using the guiding catheter lock technique.

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The guiding catheter lock technique can be useful for bailout of a stuck guidewire.