Abstract: TH-PO240
Lessons Learned in Determining Unilateral vs. Bilateral Intervention in Bilateral Renal Artery Stenosis
Session Information
- Hypertension and CVD: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Abi Doumet, Amanda, UConn Health, Farmington, Connecticut, United States
- Trivedi, Ruchir D., UConn Health, Farmington, Connecticut, United States
Introduction
Renal artery stenosis (RAS) is defined as a narrowing of one or both renal arteries. It is most frequently caused by atherosclerosis and less frequently by Fibromuscular Dysplasia (FMD) and other vascular abnormalities. Although RAS due to FMD is successfully treated with balloon angioplasty, such intervention is not as promising in atherosclerotic RAS. We present a case of a patient with bilateral RAS with successful balloon angioplasty of only the Left renal artery.
Case Description
A 46-year-old male with a history of hypertension and CKD stage IIIb presented with headaches and blurry vision. His BP was severely elevated at 209/153. His creatinine was elevated at 2.1 (baseline of 1.7). He was admitted for hypertensive emergency and underwent a workup for secondary causes of hypertension. Aldosterone/Renin ratio was 11.8/8.5 (1.4). Renal ultrasound duplex revealed a right kidney of 8.5 cm and left kidney of 11.4 cm, ostium of the right kidney was unable to be visualized and left renal artery systolic velocities were elevated. Renal angiography revealed critical mid-segment left RAS and right ostial RAS. A stent was placed in the left renal artery and the patient was started on Aspirin and Clopidogrel. Kidney function and blood pressure improved thereafter.
Discussion
RAS has many cardiovascular implications including resistant hypertension, CKD, and cardiac destabilization syndromes to name a few. Although the mainstay of treatment is medical therapy, some patients do benefit from stenting, such as those with hemodynamically significant atherosclerotic RAS and recurrent heart failure, refractory ACS, refractory hypertension, or progressive CKD due to bilateral or solitary ARAS. Although our patient had evidence of bilateral RAS, we concluded that the hemodynamically significant stenosis was that of the left renal artery. Since the left kidney was larger, we theorized that the primary stenosis was in the right kidney which led to compensatory hypertrophy of the left kidney and points to the relatively acute development of left RAS, explaining the patient’s acute presentation. Improvement in kidney function and BP after stenting the left renal artery further supports that conclusion. More studies are needed to identify which patients will benefit most from stenting, based on clinical presentation and assessment of hemodynamic significance of RAS.