Stent placement for treatment of renal artery stenosis guided by intravascular ultrasound.
OBJECTIVE
To study the impact of intravascular ultrasound (IVUS) during renal artery stent placement.


METHODS
Patients (n = 22) with atherosclerotic renal artery stenosis were studied with IVUS after predilation and after angiographically successful stent deployment (diameter stenosis < 10%). After predilation, IVUS was used to assess whether the balloon size selected angiographically was correct (discrepancy balloon-reference lumen diameter < 20%). After stent placement, IVUS images were assessed for (i) complete stent-vessel wall apposition; (ii) complete stent expansion (discrepancy stent-reference lumen diameter < 20%), and (iii) complete lesion covering by the stent. Modification based on IVUS included selection of a larger balloon, additional dilation, and placement of a second stent. Clinical outcome was based on blood pressure, amount of antihypertensive drugs, and glomerular filtration rate during follow-up of 3 months.


RESULTS
Stent placement and ultrasound imaging were completed successfully in 18 patients. After predilation, IVUS warranted the use of a larger balloon in five patients. After stent placement, incomplete stent apposition (n = 1), discrepancy between stent and reference lumen diameter (n = 3), and lesion distal to the stent (n = 2) seen on IVUS were treated with additional dilation in five patients and with a second stent in one patient. A larger balloon was used in three patients. Mean blood pressure and amount of antihypertensive drugs decreased (P < .05).


CONCLUSIONS
In a number of patients, IVUS monitoring during renal artery stent placement resulted in additional lumen enlargement not considered necessary at angiography.
Leertouwer
T C
TC
Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt and Erasmus University Rotterdam, The Netherlands.
Gussenhoven
E J
EJ
van Overhagen
H
H
Man in 't Veld
A J
AJ
van Jaarsveld
B C
BC
D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D003404:Creatinine / Q000097:blood; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000628:therapy*; D019233:Retreatment; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000959:Antihypertensive Agents; D003404:Creatinine