Successful angioplasty of renal artery stenosis due to aorto-arteritis

A 24-year-old Chinese female who suffered from hypertension and acute myocardial infarction was found to have aorto-arteritis on angiographic examination, with total occlusion of her right coronary artery and subtotal occlusion of her right renal artery. Transluminal angioplasty of her right renal artery was successfully performed and this normalized her blood pressure from 165/105 to 135/85 mm Hg.     

血管内支架成形术在症状性脑血管狭窄治疗中应用的初步探讨

目的 探讨血管内支架成形术治疗症状性脑动脉狭窄的效果及安全性.方法 对33例症状性脑动脉狭窄患者进行了37处血管内支架成形术治疗,其中颈内动脉颅外段狭窄14处,颈内动脉颅内段狭窄3处,大脑中动脉狭窄3处,椎动脉颅外段狭窄13处,椎动脉颅内段2处,锁骨下动脉2处.结果 本组33例患者行37处支架置入术,其中成功置入35枚支架,手术成功率94.59%;1例手术中并发脑血管痉挛,1例手术中并发造影剂过敏,1例手术后并发高灌注综合征.结论 血管内支架成形术治疗症状性脑动脉狭窄是安全有效的,其远期疗效尚待进一步随访观察.     

Percutaneous transluminal angioplasty of transplant renal artery stenosis

Renal artery stenosis after renal transplant is a dreaded complication. We report two cases of post-renal transplant stenosis in internal iliac artery used for end-to-end anastomosis with the graft renal artery. Both patients were successfully treated by percutaneous transluminal angioplasty with stenting of the internal iliac artery.     

Late death from aneurysm rupture following balloon angioplasty for branch pulmonary artery stenosis

We report on a child with Williams syndrome who died from aneurysm rupture 2 weeks following balloon angioplasty for branch pulmonary artery stenosis. © 1996 Wiley-Liss, Inc.     

Role of angioplasty in the treatment of renal artery stenosis

Atherosclerotic renal artery stenosis is frequent and is associated with a high incidence of morbidity and mortality, with a strong correlation with coronary artery disease, (Kalra et al., 2005; Cheung et al., 2002; Guo et al., 2007 [1], [2] and [3]). The atherosclerotic renal artery stenosis is an independent predictive factor of death (Conlon et al., 1998 [4]). The treatment of this lesion does not have strong evidence. A lot of studies in this area suggest the angioplasty is superior in a big majority between surgery, and angioplasty with stent is superior between balloon angioplasty, but some studies fail to prove the superiority of angioplasty versus medical treatment. These studies have sadly a lot of mistakes and nowadays we don’t know what is the treatment for our patients in a lot of cases. The angioplasty is indicated when there is a failure of antihypertensive medications for control of blood pressure, when it is associated with a renal insufficiency quickly progressive or when there is a lesion on each renal artery. Other studies must be organized for prove the superiority of angioplasty when there is a real stenosis, maybe with the use of fractional flow reserve.     

Use of balloon angioplasty to treat peripheral pulmonary stenosis

Balloon angioplasty was attempted in 13 children with peripheral pulmonary arterial (PA) stenosis. In 5 patients, angioplasty was successful in relieving the peripheral PA stenosis as judged by an increase in PA size of more than 75% over the predilatation size and a more than 50% reduction in the distal PA to main PA peak systolic pressure gradient. Each child has been followed for 6 to 30 months. All remain well, without signs of subsequent deterioration, and follow-up angiograms in 2 patients (at 10 and 12 months) showed persistence of anatomic and hemodynamic improvement. In 8 patients, angioplasty was unsuccessful: In 4 patients, stenosis at the site of a previous systemic-to-PA shunt could not be dilated and in 4 patients, angioplasty could not be performed because of technical difficulties. Thus, we could not dilate the stenosis in more than 60% of the patients; we also had a significant complication with the angioplasty procedure (perforation of a distal branch of the right pulmonary artery). Thus, although balloon angioplasty was not effective in all patients, it did provide significant improvement in some patients in whom traditional operative management is usually unsuccessful.     

Pinhole balloon rupture during coronary angioplasty causing rupture of the coronary artery

We report a case of pinhole balloon rupture during percutaneous transluminal coronary angioplasty using one of the newer catheters. Pinhole balloon rupture resulted in rupture and occlusion of the vessel being dilated.     

Renal artery stenosis

Opinion statement Fibromuscular dysplasia (FMD) and aortoarteritis are the most frequent causes of secondary hypertension induced by renal artery stenosis (RAS). Revascularization of this disease entity usually cures arterial hypertension. Demographic evolution leads to an increasing incidence of atherosclerotic RAS, one of the major causes of end-stage renal failure. Furthermore, atherosclerotic RAS leads to deterioration of primary hypertension, progression of atherosclerosis manifestation such as occlusive and aneurysmatic peripheral artery disease, and chronic or acute organ damage such as left ventricular hypertrophy and recurrent flash pulmonary edema. Despite the lack of sufficiently powered randomized controlled trials, each hemodynamically relevant RAS (eg, ≥ 70%) should be considered for stent angioplasty in patients without end-stage ischemic nephropathy or limited life expectancy due to concomitant disease (eg, cancer). Drug-eluting stents will probably reduce the overall low in-stent restenosis rate of 10% to 20%. Interventions in patients with dialysis-dependent end-stage nephropathy are left to appropriate clinical study protocols.     

Renal artery stenosis

Opinion statement Renal artery stenosis (RAS) can accelerate or generate progressive hypertension and renal dysfunction. The goals for treating patients with RAS are to reduce cardiovascu-lar morbidity and mortality attributable to elevated arterial pressure and to preserve renal function beyond critical stenosis. Recent, randomized trials with current anti-hypertensive agents indicate that many patients with RAS can be managed for years without renal artery revascularization. As it does elsewhere, atherosclerotic disease can progress to more severe occlusion in the renal arteries. Rapid advances in endo-vascular techniques, including stenting, make restoration of renal blood flow possible in more patients than before. Therapeutic goals are achieved by 1) avoidance of tobacco, 2) reducing arterial pressure with antihypertensive drug therapy, particularly those agents capable of blocking the renin-angiotensin system, and 3) renal revascu-larization, using balloon angioplasty and stent placement, surgical bypass, or endart-erectomy. The major clinical challenges are to identify progressive occlusive disease and to determine appropriate timing for vascular intervention.     

Renal artery stenosis

Among the indications for renal artery revascularization, either surgical or endovascular, in patients with renal artery stenosis are poorly controlled hypertension, ischemic nephropathy (preservation of renal function), or recurrent episodes of "flash" pulmonary edema and congestive heart failure. Pharmacologic treatment is the first-line therapy to control blood pressure. If the disease is unilateral, the blood pressure regimen should include an angiotensin-converting enzyme inhibitor. Guidelines published in the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of high blood pressure should be followed. Revascularization is recommended if patients have at least 75% stenosis of one or both renal arteries, combined with resistant or poorly controlled hypertension; recurrent flash pulmonary edema; dialysis-dependent renal failure resulting from renal artery stenosis; chronic renal insufficiency and bilateral renal artery stenosis; or renal artery stenosis to a solitary functioning kidney. To treat fibromuscular disease of the renal arteries, percutaneous transluminal angioplasty is the revascularization procedure of choice. Ex vivo surgical repair of the renal artery may be required if there is significant branch renal artery stenosis. To treat atherosclerotic renal artery stenosis, the revascularization procedure of choice is percutaneous transluminal angioplasty and stent implantation, especially if there is concomitant ostial or proximal renal artery disease. Surgical revascularization is performed if concomitant aortic surgery is required, such as for abdominal aortic aneurysm.     

经皮肾动脉成形术治疗肾动脉狭窄的现状

随着诊断手段和经皮介入治疗器械的进步,近10年来,经皮肾动脉成形术治疗肾动脉狭窄发展迅速,其适应证不断扩大,但什么样患者需要接受介入治疗、是否所有介入治疗均能改善血压和肾功能,目前尚存在一定争议。现在我们国内有许多心脏介入医师往往在冠状动脉造影术中做个“顺路”肾     

Captopril therapy following percutaneous transluminal angioplasty for bilateral renal artery stenosis

To establish an optimal approach for the patients with bilateral atherosclerotic renal artery stenosis, combined treatment involving percutaneous transluminal renal angioplasty and oral captopril was applied. Five patients were examined for effects of the combined treatment on blood pressure and renal function. After percutaneous transluminal renal angioplasty on one renal artery, the blood pressure (mean +/- SD) fell from 210/118 +/- 26/8 to 176/104 +/- 11/9 mm Hg without any deterioration of renal function. This reduced blood pressure was further lowered to 155/92 +/- 6/3 mm Hg by adding captopril therapy. This level of blood pressure has been maintained for an average of 37 months. Significant increases in serum creatinine concentration were not observed (124 +/- 27 vs 141 +/- 44 mumol/L), and renal size has been sustained. These results indicate that combined treatment with percutaneous transluminal renal angioplasty and captopril is effective in reducing the blood pressure and preserving renal function as an approach for the patients with bilateral atherosclerotic renal artery stenosis.     

肾动脉支架置入治疗动脉粥样硬化性肾动脉狭窄的疗效

目的评价肾动脉内支架置入治疗动脉粥样硬化性肾动脉狭窄的疗效。方法动脉粥样硬化性肾动脉狭窄51例,均成功施行肾动脉内支架置入术,定期门诊随访1年,测定血压、血生化,行计算机断层血管造影及肾动脉造影检查。结果支架置入后,高血压控制满意29%(15/51)、改善59%(30/51)、无效12%(6/51);12个月随访:高血压控制满意36%(18/51)、改善51%(26/51)、无效14%(7/51);复查肾动脉造影20例,未出现支架内再狭窄。术后1周血肌酐由术前(120±50)μmol/L降至(91±22)μmol/L,内生肌酐清除率从(56±16)ml/min升至(72±14)ml/min,外周静脉血肾素从(2.1±0.8)nmol/L降至(1.5±0.6)nmol/L,与术前相比差异均有统计学意义(P<0.05)。结论肾动脉内支架植入术是治疗动脉粥样硬化性肾动脉狭窄安全而有效的方法,对高血压临床疗效肯定,并具有一定的肾功能保护作用。     

Pseudoaneurysm of coronary artery following rupture of coronary artery during coronary angioplasty.

Rupture of the coronary artery is a rare complication of percutaneous transluminal coronary angioplasty (PTCA). We describe a case of coronary artery rupture during PTCA resulting in the formation of a coronary artery pseudoaneurysm. The pseudoaneurysm was successfully treated by percutaneous spring-coil embolization of the coronary artery.     

肾动脉狭窄26例的介入治疗

目的评价经皮肾动脉腔内成形术(PTRA)及支架术治疗肾动脉狭窄的安全性和近期疗效。方法26例经肾动脉造影确诊的肾动脉狭窄患者,造影同时或择期行PTRA和(或)支架术。观察术前、术后血管直径的变化,术中、术后并发症情况,高血压者术前、术后应用降血压药物的种类和剂量以及肾功能变化,并进行3～20个月随访。结果26例肾动脉狭窄均为单侧肾动脉狭窄,病变狭窄程度为70%～99%,平均狭窄程度为(86.4±11.2)%。狭窄病变位于肾动脉开口部18例(69%),非开口部8例(31%)。4例患者存在对侧肾脏萎缩和肾动脉直径细小。26例患者均置入支架,共置入26枚支架,直接支架术15例,同时进行PTRA11例,手术即刻成功率100%。血管内径由术前平均(1.6±0.7)mm(0.7～2.7mm)增至(5.2±1.4)mm(4.0～7.0mm)。术前肾功能不全者2例,术后肾功能均有改善。高血压患者26例,术后血压好转和治愈20例(76.9%)。围术期无并发症及死亡。结论PTRA和(或)支架术是治疗肾动脉狭窄的安全、有效的方法。