title: Stent placement for treatment of renal artery stenosis guided by intravascular ultrasound.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt and Erasmus University Rotterdam, The Netherlands.
authors.forename: T C
authors.initials: TC
authors.lastname: Leertouwer
authors.forename: E J
authors.initials: EJ
authors.lastname: Gussenhoven
authors.forename: H
authors.initials: H
authors.lastname: van Overhagen
authors.forename: A J
authors.initials: AJ
authors.lastname: Man in 't Veld
authors.forename: B C
authors.initials: BC
authors.lastname: van Jaarsveld
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine