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(Circulation. 1998;97:2575-2576.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Simultaneous Morphological and Functional Assessment of a Renal Artery Stent Intervention With Intravascular Ultrasound

Stéphane G. Carlier, MD; Wenguang Li, PhD; E. Ignacio Céspedes, PhD; Antonius F. W. van der Steen, PhD; Jaap N. Hamburger, MD; Nicolaas Bom, PhD; ; Patrick W. Serruys, MD, PhD

From Thoraxcentre Erasmus University Rotterdam, Netherlands (all authors); Interuniversity Cardiology Institute of the Netherlands (W.L., A.F.W.v.d.S., N.B., P.W.S.); and Endosonics Corp, Rancho Cordova, Calif (E.I.C.).

Correspondence to Stéphane G. Carlier, MD, Thoraxcentre Ee2302, Erasmus University Rotterdam, PO Box 1738, NL-3000 DR Rotterdam, Netherlands. E-mail carlier@tch.fgg.eur.nl

A 73-year-old woman with a history of high blood pressure and hypercholesterolemia developed medically uncontrolled hypertension (200/100 mm Hg). Serum creatinine level was 145 µmol/L, and creatinine clearance was 34 mL/min. Renal ultrasound demonstrated a small right kidney (80 mm long) compared with the left one (92 mm long). Left ventricular hypertrophy was present on the ECG and was confirmed by echocardiography. On isotope radiography with ^99mTc-mercaptoacetyltriglycine after oral intake of 25 mg captopril, the right kidney was small, with delayed excretion and impaired function (36%). Renal arteriography showed subocclusive ostial stenosis of the right renal artery.

The lesion was related to a calcified plaque extending from the aortic wall into the renal artery ostium (angiogram I in Figure 1, arrow). After an unsuccessful angioplasty attempt in the interventional radiology department (failure to cross the stenosis), the patient was investigated in the cardiac catheterization laboratory. The lesion was crossed with a hydrophilic guidewire and predilated. A short (9-mm) stent was then implanted by use of a 4.5-mm balloon inflated up to 18 atm for postdilatation (angiogram II).

View larger version (88K): [in this window] [in a new window]   Figure 1. Angiograms before (I), during (II), and after (III) stent implantation in right renal artery. Tight stenosis is indicated by arrow in angiogram I. Intravascular ultrasound (IVUS) images (1 through 3) obtained after stenting at corresponding levels indicated by arrows in angiogram III. Arrows in IVUS panel 2 show well-apposed struts of stent, and in panel 3, calcified plaque at junction with aorta (Ao).

The immediate result of the intervention was . . . [Full Text of this Article]