Cutting balloon angioplasty for resistant renal artery in-stent restenosis.
A 76-year-old woman presented with recurrent arterial hypertension 6 months after uncomplicated primary renal artery stent placement. Diagnostic arteriography revealed severe renal artery in-stent restenosis. On repeat intervention, the lesion was resistant to attempted conventional percutaneous transluminal angioplasty (PTA) with unchanged systolic pressure gradients across the stent. Cutting balloon angioplasty (CBA) was performed with use of a 4-mm cutting balloon (IVT, San Diego, CA). CBA successfully reduced the pressure gradient to below the level of significance. Subsequent conventional PTA enhanced the lumen diameter inside the stent. The arterial hypertension reverted to normal values and duplex ultrasonography (US) at 10-month follow-up demonstrated normal renal artery hemodynamics without stenosis. CBA for potential use in renal artery in-stent restenosis and other peripheral neointimal hyperplasia is discussed.
Munneke
Graham J
GJ
Department of Radiology, St. George's Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
Engelke
Christoph
C
Morgan
Robert A
RA
Belli
Anna-Maria
AM
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D005260:Female; D006801:Humans; D011859:Radiography; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D015607:Stents / Q000009:adverse effects*; D014463:Ultrasonography