Eto Ryo, Kawano Hiroaki, Akashi Ryohei, Ikeda Satoshi, Maemura Koji
Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Cardiol Cases. 2022 Apr 16;26(2):114-117. doi: 10.1016/j.jccase.2022.03.016. eCollection 2022 Aug.
Percutaneous transluminal renal angioplasty (PTRA) is an effective treatment for renovascular hypertension due to fibromuscular dysplasia (FMD). PTRA for renovascular FMD is performed with only balloons based on the consensus that stent kinking and fracture have been reported in cases of PTRA using stents for FMD. Therefore, it is important to avoid procedural complications, such as flow-limiting dissection or arterial rupture, in PTRA for renovascular FMD.We present a case of a juvenile patient who presented with renovascular hypertension due to FMD. Angiography revealed focal stenosis of the right renal artery, and the pressure wire showed a resting distal coronary to aortic pressure ratio (Pd/Pa) of 0.83. Intravascular ultrasound (IVUS) showed an intima-media complex that could not be qualitatively assessed. Optical coherence tomography (OCT) showed intimal fibroplasia and medial hyperplasia with areas of low intensity. Based on the OCT images, balloon angioplasty was performed using a semi-compliant balloon. After balloon angioplasty, IVUS and OCT revealed luminal expansion with mild residual stenosis, and the Pd/Pa ratio was 0.99. We decided not to increase the balloon size to avoid vascular injuries. In conclusion, PTRA with only balloon can be safely performed for FMD under the guidance of multimodal imaging, using IVUS, OCT, and a pressure wire.
This report describes successful percutaneous transluminal renal angioplasty (PTRA) for a juvenile patient with renovascular hypertension due to fibromuscular dysplasia (FMD) under the guidance of multimodal imaging, using intravascular ultrasound (IVUS), optical coherence tomography (OCT), and a pressure wire. When IVUS for FMD cannot assess the culprit lesion qualitatively, OCT could be effective in performing angioplasty with only balloon, without significant vascular injuries. A pressure wire can show the endpoint of PTRA and help avoid increasing the balloon size to prevent significant vascular injuries.
经皮腔内肾血管成形术（PTRA）是治疗纤维肌性发育异常（FMD）所致肾血管性高血压的有效方法。基于在FMD患者PTRA使用支架时已报道有支架扭结和断裂的共识，肾血管性FMD的PTRA仅使用球囊进行。因此，在肾血管性FMD的PTRA中，避免诸如限流性夹层或动脉破裂等操作并发症很重要。我们报告一例因FMD导致肾血管性高血压的青少年患者。血管造影显示右肾动脉局灶性狭窄，压力导丝显示静息状态下远端冠状动脉与主动脉压力比值（Pd/Pa）为0.83。血管内超声（IVUS）显示内膜-中膜复合体无法进行定性评估。光学相干断层扫描（OCT）显示内膜纤维化和中膜增生，伴有低强度区域。基于OCT图像，使用半顺应性球囊进行球囊血管成形术。球囊血管成形术后，IVUS和OCT显示管腔扩张，残留轻度狭窄，Pd/Pa比值为0.99。我们决定不增加球囊尺寸以避免血管损伤。总之，在多模态成像（使用IVUS、OCT和压力导丝）的引导下，仅使用球囊的PTRA可安全地用于FMD。
本报告描述了在多模态成像（使用血管内超声（IVUS）、光学相干断层扫描（OCT）和压力导丝）引导下成功对一名因纤维肌性发育异常（FMD）导致肾血管性高血压的青少年患者进行经皮腔内肾血管成形术（PTRA）。当FMD的IVUS无法对罪犯病变进行定性评估时，OCT可有效地仅使用球囊进行血管成形术，而不会造成明显的血管损伤。压力导丝可显示PTRA的终点，并有助于避免增加球囊尺寸以防止明显的血管损伤。
