Patel Pranav M, Eisenberg Jonathan, Islam M Ashequl, Maree Andrew O, Rosenfield Kenneth A
Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Vasc Med. 2009 Aug;14(3):259-64. doi: 10.1177/1358863X08100386.
Percutaneous renal artery stenting is a common means of treating atherosclerotic renal artery stenosis. However, renal artery restenosis remains a frequent problem. The optimal treatment of restenosis has not been established and may involve percutaneous renal artery angioplasty or deployment of a second stent. Other modalities include cutting balloon angioplasty, repeat stenting with drug-eluting stents or endovascular brachytherapy. Most recently, use of polytetrafluoroethylene (PTFE)-covered stents may offer a new and innovative way to treat recurrent renal artery stenosis. We describe a case in a patient who initially presented with renal insufficiency and multi-drug hypertension in the setting of severe bilateral renal artery stenosis. Her renal artery stenosis was initially successfully treated by percutaneous deployment of bilateral bare metal renal artery stents. After initial improvement of her hypertension and renal insufficiency, both parameters declined and follow-up duplex evaluation confirmed renal artery in-stent restenosis. Owing to other medical co-morbidities she was felt to be a poor surgical candidate and was subsequently treated first with bilateral cutting balloon angioplasty and second with drug-eluting stent deployment. Each procedure was associated with initial improvement of renal function and blood pressure control, which then later deteriorated with the development of further significant in-stent restenosis. It was then decided to treat the restenosis using PTFE-covered stents. At 12 months of follow-up, the blood pressure had remained stable and renal function had normalized. The covered stents remained free of any significant neointimal tissue or obstruction.
经皮肾动脉支架置入术是治疗动脉粥样硬化性肾动脉狭窄的常用方法。然而，肾动脉再狭窄仍然是一个常见问题。再狭窄的最佳治疗方法尚未确定，可能包括经皮肾动脉血管成形术或植入第二个支架。其他方法包括切割球囊血管成形术、使用药物洗脱支架重复支架置入术或血管内近距离放射治疗。最近，使用聚四氟乙烯（PTFE）覆膜支架可能为治疗复发性肾动脉狭窄提供一种新的创新方法。我们描述了一例患者，该患者最初因严重双侧肾动脉狭窄出现肾功能不全和多种药物治疗无效的高血压。她的肾动脉狭窄最初通过经皮双侧裸金属肾动脉支架置入术成功治疗。在高血压和肾功能不全最初改善后，这两个指标均下降，后续的双功超声评估证实肾动脉支架内再狭窄。由于存在其他合并症，她被认为不适合手术，随后先接受双侧切割球囊血管成形术治疗，然后植入药物洗脱支架。每次治疗后肾功能和血压控制均有初始改善，但随后随着支架内再狭窄进一步加重而恶化。随后决定使用PTFE覆膜支架治疗再狭窄。随访12个月时，血压保持稳定，肾功能恢复正常。覆膜支架未出现任何明显的新生内膜组织或阻塞。
