title: Transradial approach for renal artery stenting.
abstract: Percutaneous interventional procedures in the renal arteries are usually performed using a femoral or brachial vascular access. The transradial approach, which has been extensively investigated for coronary angiography and intervention, could be an attractive new technique for renal artery angioplasty and stenting. In 18 patients with hemodynamically relevant unilateral renal artery stenosis (mean diameter stenosis, 83% +/- 18%; right, n = 7; left, n = 11), interventional treatment with PTA and stenting was performed using a left (n = 16) or right (n = 2) radial artery access. Indications for the transradial approach were acute aorto-renal angles or severe peripheral arterial obstructions. After engagement of the renal artery ostium with a 6 Fr Multipurpose guiding catheter (length, 125 cm; Cordis) the stenosis was passed with a 0.014" guidewire followed by stent implantation (ACS Multi-Link RX Ultra, Guidant; length, 18 mm; diameter, 5 mm). Direct stenting was successfully performed in 16 cases. Predilatations were required in two cases. In five patients, optimal stent expansion was achieved by additional postdilatations. A primary technical success (residual stenosis < 30%) could be achieved in all cases. There were no periprocedural complications. According to color-coded doppler ultrasound, all access site arteries showed a normal perfusion. Clinically blood pressure control was improved in 11 patients with a significant reduction in systolic and diastolic blood pressure values. Serum creatinine values dropped from 1.81 +/- 0.3 mg/dl to 1.49 +/- 0.3 mg/dl (P < 0.001). Transradial renal artery angioplasty and stenting is technically feasible and safe. Particularly in patients with unfavorable vessel anatomy, this new cranio-caudal approach is an attractive alternative technique.
authors.affiliation: Department of Cardiology and Angiology, University of Erlangen, Nürnberg, Germany. dierk.scheinert@gmxz.de
authors.forename: D
authors.initials: D
authors.lastname: Scheinert
authors.forename: S
authors.initials: S
authors.lastname: Bräunlich
authors.forename: B
authors.initials: B
authors.lastname: Nonnast-Daniel
authors.forename: M
authors.initials: M
authors.lastname: Schroeder
authors.forename: A
authors.initials: A
authors.lastname: Schmidt
authors.forename: G
authors.initials: G
authors.lastname: Biamino
authors.forename: W G
authors.initials: WG
authors.lastname: Daniel
authors.forename: J
authors.initials: J
authors.lastname: Ludwig
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000502:physiology; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D017534:Radial Artery; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000503:physiopathology / Q000628:therapy; D015607:Stents; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D000959:Antihypertensive Agents; D003404:Creatinine