Renal artery stenosis in children: therapeutic percutaneous balloon and stent angioplasty.
BACKGROUND
Renal artery stenosis (RAS) accounts for 10 % of cases of systemic hypertension in children. Initial management involves anti-hypertensive therapy. Percutaneous interventions are documented for the treatment of RAS in the adult population. In children, case reports suggest benefit.


METHODS
This is a retrospective analysis of consecutive patients referred for catheterization for RAS between 2002 and 2010 at a single institution. Recorded variables included: age, weight, systemic blood pressure, minimal luminal diameter, interventional devices, antihypertensive medications, contrast volume, and complications.


RESULTS
Twelve patients (median age 8.2, IQR 6-12.4 years); median weight 42.8 kg, IQR: 25-47.4 kg) were referred for renal artery catheterization and underwent percutaneous intervention. Overall, minimal luminal diameter (MLD) increased by 1.2 ± 0.9 mm for all patients (p < 0.05) and by 1.3 ± 0.9 mm for post-renal transplant patients (p < 0.05). Only stent angioplasty patients demonstrated significant improved blood pressure (p < 0.05). One patient had stent thrombosis requiring re-intervention with repeat balloon angioplasty.


CONCLUSIONS
This retrospective analysis suggests that percutaneous intervention might play a role in the management of RAS, with an improvement in MLD in children with RAS. Transcatheter intervention is technically feasible with low morbidity. A prospective, longitudinal study is warranted to compare standard medical therapy with percutaneous interventions.
Children's National Heart Institute, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
Jessica H
JH
Colyer
Kanishka
K
Ratnayaka
Michael C
MC
Slack
Joshua P
JP
Kanter
D017130:Angioplasty / Q000379:methods*; D000800:Angioplasty, Balloon; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007223:Infant; D008297:Male; D012078:Renal Artery Obstruction / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D055815:Young Adult