Refractory hypertension secondary to renal artery stenosis with a honeycomb-like structure

BMC Cardiovasc Disord. 2021 Dec 20;21(1):606. doi: 10.1186/s12872-021-02428-1.

Abstract

Background: A honeycomb-like structure (HLS) is a rare abnormality characterized by a braid-like appearance. Angiograph and intravascular examination, including coherence tomography and intravascular ultrasound (IVUS), can further confirm the multiple intraluminal channels or honeycomb structure, which can also be described as looking like 'swiss cheese', a 'spider web' or a 'lotus root'. Previous studies have mostly reported this abnormality in coronary arteries, with a few cases in renal arteries. More information about the characteristics and development of HLS is needed.

Case presentation: A 69-year-old Han man with resistant hypertension received abdominal enhanced computerised tomography and was revealed to have left renal artery stenosis with the possibility of left renal infarction. Renal artery angiography confirmed a 95% stenosis located in the proximal segment of the left renal artery, and the middle segment was blurred with multi-channel-like blood flow. Further IVUS was performed and identified multiple channels surrounded by fibrous tissue. It was a rare case of HLS in the renal artery secondary to the thrombus, with organisation and recanalisation. Balloon dilatation and stent implantation at the proximal segment of the left renal artery were performed successfully. Blood pressure was well controlled after the procedure.

Conclusions: The IVUS findings are helpful for forming interventional therapeutic strategies for HLS lesions in the renal artery.

Keywords: Case report; Honeycomb-like structure; IVUS; Renal artery stenosis; Secondary hypertension.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Aged
  • Angiography
  • Angioplasty, Balloon* / instrumentation
  • Humans
  • Hypertension, Renovascular / diagnosis
  • Hypertension, Renovascular / etiology
  • Hypertension, Renovascular / physiopathology
  • Hypertension, Renovascular / therapy*
  • Male
  • Renal Artery / abnormalities*
  • Renal Artery / diagnostic imaging
  • Renal Artery / physiopathology
  • Renal Artery Obstruction / complications
  • Renal Artery Obstruction / diagnostic imaging
  • Renal Artery Obstruction / physiopathology
  • Renal Artery Obstruction / therapy*
  • Stents
  • Treatment Outcome
  • Ultrasonography, Interventional