Limitations of angiography for the assessment of renal artery stenosis and treatment implications.
Renovascular hypertension due to atherosclerotic renal artery stenosis is the most common cause of secondary hypertension. Percutaneous catheter-based renal artery revascularization has been increasingly utilized for the treatment of renal artery stenosis. Renal artery stenting has a high technical success rate, but the rate of improvement in hypertension is somewhat less than expected with this technique. Misinterpretation of angiographic images may play a role in these unfavorable clinical results. We present a case in which the diagnosis of severe renal artery stenosis was not apparent by angiography. Intravascular ultrasound and translesional pressure gradient measurements during arteriography can help to determine the precise severity of stenosis and may augment the clinical results of percutaneous renal artery stent placement.
Cam
Akin
A
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Chhatriwalla
Adnan K
AK
Kapadia
Samir R
SR
D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001794:Blood Pressure; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011859:Radiography; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional