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Baba BA, Sethi A, Goyal NK. Simultaneous Kissing Balloon Stenting Technique in Management of Two Branches of Right Renal Artery Bifurcation: A Case Report. Indian J Nephrol 2022; 32:618-620. [PMID: 36704606 PMCID: PMC9872919 DOI: 10.4103/ijn.ijn_202_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 04/12/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Bilal Ahmad Baba
- Department of Cardiology BLK Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Arvind Sethi
- Department of Cardiology BLK Superspeciality Hospital, Pusa Road, New Delhi, India
| | - Naresh Kumar Goyal
- Department of Cardiology BLK Superspeciality Hospital, Pusa Road, New Delhi, India
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Vijayvergiya R, Kasinadhuni G, Bootla D, Rajan P, Sharma A, Lal A. Intravascular ultrasound-supported percutaneous angioplasty of post-kidney transplant renal artery bifurcation stenosis. Vascular 2021; 30:167-170. [PMID: 33730955 DOI: 10.1177/17085381211001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transplant renal artery stenosis (TRAS) is an uncommon complication following renal transplantation. Its usual clinical presentation includes worsening hypertension and/or renal function, without any evidence of graft rejection. Bifurcation renal artery stenosis of the transplanted renal artery is rarely encountered. METHODS Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the procedure of choice to treat TRAS. We hereby describe a patient, who presented with impaired renal functions, four months following the renal transplantation. He underwent intravascular ultrasound-guided PTRA of the bifurcation lesion of TRAS.Results and conclusion: Superior renal artery had coronary drug-eluting stent implantation, while inferior renal artery and side branch of the superior renal artery had balloon angioplasty, alone. Post-intervention, the raised serum creatinine level decreased from 2.9 mg% to 1.7 mg%. The index case described the successful PTRA and stenting of the bifurcation lesion of TRAS, the technical results of which was optimized with the use of intravascular ultrasound.
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Affiliation(s)
- Rajesh Vijayvergiya
- Department of Cardiology, Renal Transplant Surgery, Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Renal Transplant Surgery, Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Renal Transplant Surgery, Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Palanivel Rajan
- Department of Cardiology, Renal Transplant Surgery, Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashish Sharma
- Department of Cardiology, Renal Transplant Surgery, Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Anupam Lal
- Department of Cardiology, Renal Transplant Surgery, Radio-diagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Lopes A, Gomes ML, Melo R, Amorim P, Sobrinho G, Pedro LM. An Original Bailout Solution for Renal Artery Dissection after Fenestrated/Branched EVAR. Ann Vasc Surg 2019; 65:286.e1-286.e4. [PMID: 31712189 DOI: 10.1016/j.avsg.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Renal artery (RA) dissection may occur during endovascular treatment of thoracoabdominal aneurysms. The aim of this paper is to report the use of kissing coronary stents in the renal bifurcation as a bailout solution for dissection after fenestraded/branched endovascular aortic repair (F/B-EVAR). METHODS/RESULTS A 73-year-old male with an asymptomatic Crawford type 4 thoracoabdominal aneurysm and a concomitant right common iliac artery aneurysm was proposed for endovascular repair, consisting of thoracic endovascular aortic repair plus custom-made device F/B-EVAR, followed by staged bifurcated EVAR plus right-sided IBD. In the control angiogram of the first procedure, a distal occlusion of the left renal artery was observed and attributed to iatrogenic dissection. The 6F sheath was reintroduced and the two main branches of the RA were catheterized with 0.014 wires. Then, two coronary drug-eluting stents were used for a kissing stenting technique with good angiographic and clinical results. As planned, one week later the patient underwent an uneventful second stage procedure. Follow-up CTA at 1 year showed normal patency of the renal stents as well as aneurysm shrinking and no signs of endoleak. CONCLUSIONS In the reported case, the use of coronary stents was a safe and long-lasting solution to rescue an iatrogenic renal artery dissection during F/B-EVAR.
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Affiliation(s)
- Alice Lopes
- Vascular Surgery Department - Heart and Vessels Division, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Lisbon Academic Medical Center, Lisbon, Portugal.
| | - Miguel Lemos Gomes
- Vascular Surgery Department - Heart and Vessels Division, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Lisbon Academic Medical Center, Lisbon, Portugal
| | - Ryan Melo
- Vascular Surgery Department - Heart and Vessels Division, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Lisbon Academic Medical Center, Lisbon, Portugal
| | - Pedro Amorim
- Vascular Surgery Department - Heart and Vessels Division, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Lisbon Academic Medical Center, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Gonçalo Sobrinho
- Vascular Surgery Department - Heart and Vessels Division, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Lisbon Academic Medical Center, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Department - Heart and Vessels Division, Hospital de Santa Maria (CHULN), Lisbon, Portugal; Lisbon Academic Medical Center, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Mkangala AM, Mayala HA, Bakari KH, Dong XJ. Kissing stent management of stenosis of two branches of left renal artery bifurcation: a case report. J Med Case Rep 2019; 13:197. [PMID: 31248449 PMCID: PMC6598259 DOI: 10.1186/s13256-019-2119-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/09/2019] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
- Abdala M Mkangala
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China.
| | - Henry A Mayala
- Department of Cardiology, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Khamis H Bakari
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
| | - Xiang J Dong
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, China
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Okumura K, Vidi S, Desai DM. Renal auto transplantation for renovascular hypertension associated with bifurcated renal artery stenosis in a pediatric patient. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Hasija P, Chadha D, Kalra R. Kissing stenting of aorto-ostial lesions in juxtaposed renal arteries. BMJ Case Rep 2014; 2014:bcr-2014-205373. [PMID: 25199194 DOI: 10.1136/bcr-2014-205373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Percutaneous angioplasty with or without stenting has become an established procedure for treatment of renal artery stenosis for control of hypertension or progressive renal dysfunction. Anatomic variation of renal arteries is common with dual blood supply of unilateral kidney noted in almost 25% of the general population. Renal angioplasty of these anatomic variants of renal arteries is challenging. We present an unusual case of juxtaposed renal arteries with aorto-ostial lesion where direct kissing stenting was done with excellent technical and clinical outcome.
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Affiliation(s)
- Pradeep Hasija
- Department of Cardiology, MH (CTC), Pune, Maharashtra, India
| | - Davinder Chadha
- Department of Cardiology, MH (CTC), Pune, Maharashtra, India
| | - Ravi Kalra
- Department of Cardiology, INHS Aswini, Mumbai, Maharashtra, India
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Auricchio F, Conti M, Ferrazzano C, Sgueglia GA. A simple framework to generate 3D patient-specific model of coronary artery bifurcation from single-plane angiographic images. Comput Biol Med 2013; 44:97-109. [PMID: 24377693 DOI: 10.1016/j.compbiomed.2013.10.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 09/30/2013] [Accepted: 10/28/2013] [Indexed: 11/26/2022]
Abstract
Although computer-based simulations, such as structural finite element analysis, have proven their usefulness to support procedural planning of coronary stenting, the link between the clinical practice and these engineering techniques is still limited to research test-cases. A key point to further promote such an interaction is to generate in a fast and effective manner the computational grids from the medical images. Hence, the present study proposes a simple framework to generate 3D meshes of coronary bifurcations from a pair of planar angiographic images obtained by X-ray angiography, which is the gold standard technique for the diagnosis of coronary artery stenosis.
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Affiliation(s)
- Ferdinando Auricchio
- Dipartimento di Ingegneria Civile e Architettura, Università degli Studi di Pavia, via Ferrata 1, 27100 Pavia, Italy; CESNA - Centro di Simulazione Numerica Avanzata, Pavia, Italy; IUSS - Istituto Universitario degli Studi Superiori di Pavia, Piazza della Vittoria 15, 27100 Pavia, Italy
| | - Michele Conti
- Dipartimento di Ingegneria Civile e Architettura, Università degli Studi di Pavia, via Ferrata 1, 27100 Pavia, Italy
| | - Carolina Ferrazzano
- IUSS - Istituto Universitario degli Studi Superiori di Pavia, Piazza della Vittoria 15, 27100 Pavia, Italy.
| | - Gregory A Sgueglia
- UOC Cardiologia, Ospedale Sant'Eugenio, Piazzale dell'Umanesimo 10, 00144 Rome, Italy
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Pu LJ, Shen Y, Zhang RY, Zhang Q, Lu L, Ding FH, Hu J, Yang ZK, Shen WF. Screening for significant atherosclerotic renal artery stenosis with a regression model in patients undergoing transradial coronary angiography/intervention. J Zhejiang Univ Sci B 2012; 13:631-7. [PMID: 22843183 DOI: 10.1631/jzus.b1201003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Early detection of atherosclerotic renal artery stenosis (ARAS) is clinically important with respect to blood pressure control, prevention of renal insufficiency, and even improving survival. We investigated whether the presence of significant ARAS (luminal diameter narrowing ≥70%) could be predicted using a logistic regression model before coronary angiography/intervention. METHODS Initially, we developed a logistic regression model for detecting significant ARAS based upon clinical and angiographic features and biochemical measurements in a cohort of 1813 patients undergoing transfemoral coronary and renal angiography. This model was then prospectively applied to an additional 495 patients who received transradial renal angiography to ascertain its predictive accuracy for the presence of significant ARAS. RESULTS Multivariate regression analysis revealed that older age (≥65 years), resistant hypertension, type 2 diabetes, creatinine clearance (Ccr) ≤60 ml/min, and multivessel coronary disease were independent predictors for significant ARAS. A logistic regression model for detecting ARAS by incorporating conventional risk factors and multivessel coronary disease was generated as: P/(1-P)=exp(-2.618+1.112[age≥65 years]+1.891[resistant hypertension]+0.453[type 2 diabetes]+0.587[Ccr≤60 ml/min]+2.254[multivessel coronary disease]). When this regression model was prospectively applied to the additional 495 patients undergoing transradial coronary and renal angiography, significant ARAS could be detected with a sensitivity of 81.2%, specificity of 88.9%, and positive and negative predictive accuracies of 53.8% and 96.7%, respectively. CONCLUSIONS The logistic regression model generated in this study may be useful for screening for significant ARAS in patients undergoing transradial coronary angiography/intervention.
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Affiliation(s)
- Li-jin Pu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Stents in renal artery bifurcation stenosis: a case report. Case Rep Med 2011; 2011:653143. [PMID: 21789043 PMCID: PMC3140787 DOI: 10.1155/2011/653143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/07/2011] [Indexed: 12/02/2022] Open
Abstract
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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