Percutaneous transluminal renal artery stenting using digital subtraction angiography with diluted contrast medium in a patient with severe chronic kidney disease

Abstract

Atherosclerotic renal artery stenosis (ARAS) is associated with ischemic nephropathy, kidney failure, and secondary hypertension. Percutaneous transluminal renal artery stenting (PTRAS) is required for patients with hemodynamically significant ARAS. However, PTRAS can be problematic in patients with chronic kidney disease (CKD) because the use of a large amount of iodinated contrast medium is associated with an increased risk of contrast-induced nephropathy. We describe a case of PTRAS with successful revascularization by using digital subtraction angiography (DSA) with diluted contrast medium (1:10 dilution). An 89-year-old man with resistant hypertension and CKD was hospitalized in our institution for acute coronary syndrome. During hospitalization, the patient's blood pressure was extremely high (180-200/70-90 mmHg), despite the use of four antihypertensive agents. We examined the cause of hypertension and detected significant right renal artery stenosis and left kidney atrophy with renal artery obstruction. We performed PTRAS on the right renal artery by using DSA with a diluted contrast medium. Revascularization was successful using only 3 mL of the contrast medium. PTRAS using DSA with diluted contrast medium can be an effective technique for treating ARAS in patients with CKD to preserve renal function.

Learning objectives: Atherosclerotic renal artery stenosis (ARAS) is associated with ischemic nephropathy, kidney failure, and secondary hypertension. Percutaneous transluminal renal artery stenting (PTRAS) is required for patients with hemodynamically significant ARAS. However, PTRAS can be problematic in patients with chronic kidney disease because of the increased risk of contrast-induced nephropathy. We describe a technique of PTRAS using digital subtraction angiography with a diluted contrast medium to achieve a successful revascularization.

Keywords: Atherosclerotic renal artery stenosis; Contrast-induced nephropathy; Digital subtraction angiography; Diluted contrast medium; Percutaneous transluminal renal artery stenting.