This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Scopus Google Scholar Articles by Patel, P. M Articles by Rosenfield, K. A PubMed PubMed Citation Articles by Patel, P. M Articles by Rosenfield, K. A Social Bookmarking                         What's this?

Percutaneous revascularization of persistent renal artery in-stent restenosis

Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical Schoolpranavp{at}uci.edu

Jonathan Eisenberg

Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School

M Ashequl Islam

Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School

Andrew O Maree

Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School

Kenneth A Rosenfield

Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School

Abstract

Percutaneous renal artery stenting is a common means of treating atherosclerotic renal artery stenosis. However, renal artery restenosis remains a frequent problem. The optimal treatment of restenosis has not been established and may involve percutaneous renal artery angioplasty or deployment of a second stent. Other modalities include cutting balloon angioplasty, repeat stenting with drug-eluting stents or endovascular brachytherapy. Most recently, use of polytetrafluoroethylene (PTFE)-covered stents may offer a new and innovative way to treat recurrent renal artery stenosis. We describe a case in a patient who initially presented with renal insufficiency and multi-drug hypertension in the setting of severe bilateral renal artery stenosis. Her renal artery stenosis was initially successfully treated by percutaneous deployment of bilateral bare metal renal artery stents. After initial improvement of her hypertension and renal insufficiency, both parameters declined and follow-up duplex evaluation confirmed renal artery in-stent restenosis. Owing to other medical co-morbidities she was felt to be a poor surgical candidate and was subsequently treated first with bilateral cutting balloon angioplasty and second with drug-eluting stent deployment. Each procedure was associated with initial improvement of renal function and blood pressure control, which then later deteriorated with the development of further significant in-stent restenosis. It was then decided to treat the restenosis using PTFE-covered stents. At 12 months of follow-up, the blood pressure had remained stable and renal function had normalized. The covered stents remained free of any significant neointimal tissue or obstruction.

Key Words: peripheral vascular diseases • renal artery • renal artery obstruction • stents

Vascular Medicine, Vol. 14, No. 3, 259-264 (2009)
DOI: 10.1177/1358863X08100386


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?