Chronic total occlusion and successful drug-eluting stent placement in Takayasu arteritis-induced renal artery stenosis

Abstract

Takayasu arteritis-induced renal artery stenosis (TARAS) is a condition rarely described in the literature. Although percutaneous transluminal angioplasty and stenting has been well-described in the treatment of atherosclerotic renal artery stenosis, its role has not been established in non-atherosclerotic TARAS. We report a case of a female, age 17 years, with Takayasu arteritis who presented to the hospital with seizures and hypertensive crisis. A renal angiogram showed chronic total occlusion (CTO) of the left renal artery. Renal angioplasty and stenting was successfully performed after multiple attempts to deliver a wire distal to the CTO. After sequential balloon predilation, a drug-eluting stent was deployed, resulting in full reperfusion of the kidney. The patient's blood pressure improved dramatically, and patency of the stent was demonstrated with magnetic resonance angiography over 9 months after the procedure.

Keywords: Hypertension, renovascular; Renal artery stenosis; Takayasu arteritis.

Figure 1

(a) Patent two right renal arteries (arrows) but no visible left renal artery on aortogram. (b) Selective angiography showed small stump off aorta (arrow). (c) Wire passed through distal to chronic total occlusion (arrow). (d) Dilatation with smaller diameter balloon showed reperfusion. (e) Deployment of drug-eluting stent (arrow). (f) Images of stent expanded with balloon and full reperfusion.

Figure 1

(a) Patent two right renal arteries (arrows) but no visible left renal artery on aortogram. (b) Selective angiography showed small stump off aorta (arrow). (c) Wire passed through distal to chronic total occlusion (arrow). (d) Dilatation with smaller diameter balloon showed reperfusion. (e) Deployment of drug-eluting stent (arrow). (f) Images of stent expanded with balloon and full reperfusion.

Figure 1

(a) Patent two right renal arteries (arrows) but no visible left renal artery on aortogram. (b) Selective angiography showed small stump off aorta (arrow). (c) Wire passed through distal to chronic total occlusion (arrow). (d) Dilatation with smaller diameter balloon showed reperfusion. (e) Deployment of drug-eluting stent (arrow). (f) Images of stent expanded with balloon and full reperfusion.

Figure 2

(A) Magnetic resonance angiogram (MRA) with maximum intensity projection demonstrating cobalt chromium stent (black) with perfusion post-stent. (B) MRA cross sectional view demonstrating stent patency.

Figure 2

(A) Magnetic resonance angiogram (MRA) with maximum intensity projection demonstrating cobalt chromium stent (black) with perfusion post-stent. (B) MRA cross sectional view demonstrating stent patency.