Department of Pediatric Nephrology.
Department of Cardiology, Fondazione Policlinico 'Ca' Granda" IRCCS, Milan.
J Hypertens. 2022 Oct 1;40(10):1902-1908. doi: 10.1097/HJH.0000000000003162. Epub 2022 Aug 18.
Percutaneous transluminal renal angioplasty (PTRA), the recommended treatment in children with renovascular hypertension (RVH), often has unsatisfactory outcomes. Cutting balloons may improve the results of angioplasty in different vascular beds with complex and resistant lesions. We retrospectively analysed the effects of percutaneous cutting balloon angioplasty (PCBA) on blood pressure, cardiac mass and renal artery acceleration time in children/adolescents referred to our centre for RVH.
Thirteen patients (aged 9-19 years) with renal artery stenosis (RAS) and severe hypertension were identified. RASs were focal fibromuscular (FMD) or FMD-like dysplasia (in six cases bilateral, in five associated with mid aortic syndrome). Ten patients had uncontrolled hypertension, in nine cases associated with left ventricular hypertrophy (LVH). Acceleration time was abnormal in all stenotic arteries. Eighteen PCBA were performed, in three arteries associated with stent implantation.
PCBA was technically successful in all individuals without major complications. In one patient, an intra-stent restenosis occurred, successfully redilated with conventional angioplasty without recurrence at 4 years distance. One year after PCBA, mean SBP and DBPs were markedly reduced from 146 ± 25 to 121 ± 10 mmHg and from 87 ± 11 to 65 ± 12 mmHg, respectively ( P < 0.001 for both). At that time, hypertension was cured in seven children and controlled in five individuals. This favourable outcome was confirmed with ambulatory blood pressure measurement in four patients. At the latest follow-up, left ventricular mass and acceleration time were normal in all patients.
PCBA proved to be a well tolerated and effective procedure that can be considered as an alternative to PTRA to treat hypertensive children/adolescents with recurrent or resistant RAS.
经皮腔内血管成形术（PTRA）是治疗肾血管性高血压（RVH）的推荐治疗方法，但往往效果不佳。切割球囊可能会改善不同血管床复杂和耐药病变血管成形术的结果。我们回顾性分析了经皮切割球囊血管成形术（PCBA）对因 RVH 而转诊至我们中心的儿童/青少年的血压、心脏质量和肾动脉加速时间的影响。
确定了 13 名患有肾动脉狭窄（RAS）和严重高血压的患者（年龄 9-19 岁）。RAS 为局灶性纤维肌性（FMD）或 FMD 样发育不良（6 例双侧，5 例与中主动脉综合征相关）。10 例患者存在未控制的高血压，9 例患者伴有左心室肥厚（LVH）。所有狭窄动脉的加速时间均异常。共进行了 18 次 PCBA，其中 3 次与支架植入相关。
所有患者的 PCBA 技术均成功，无重大并发症。在一名患者中，发生了支架内再狭窄，经传统血管成形术成功扩张，4 年后无复发。PCBA 后 1 年，平均 SBP 和 DBP 分别从 146±25mmHg 显著降至 121±10mmHg 和 87±11mmHg（均 P<0.001）。此时，7 名儿童高血压被治愈，5 名患者血压得到控制。四名患者的动态血压测量证实了这一有利结果。在最近的随访中，所有患者的左心室质量和加速时间均正常。
PCBA 被证明是一种耐受良好且有效的方法，可以替代 PTRA 治疗复发性或耐药性 RAS 的高血压儿童/青少年。
