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. 2013 Dec 13;9(1):18-21.
doi: 10.1016/j.jccase.2013.08.014. eCollection 2014 Jan.

Nonobstructive angioscopy in patient with atherosclerotic renal artery stenosis

Sei Komatsu  1 , Tomoki Ohara  1 , Mitsuhiko Takewa  1 , Satoru Takahashi  1 , Takeshi Nomamoto  2 , Teruaki Kamata  2 , Koichi Nishiuchi  2 , Yasuhiko Kobayashi  1 , Kazuhisa Kodama  1
Affiliations

Nonobstructive angioscopy in patient with atherosclerotic renal artery stenosis

Sei Komatsu et al. J Cardiol Cases. .

Abstract

Few applications of angioscopy for evaluating atherosclerosis of the abdominal aorta have been described. We report the demonstration of atherosclerotic yellow plaque by nonobstructive angioscopy in a patient with left renal artery stenosis. Computed tomography angiography showed stenosis in one of the left renal arteries in a 65-year-old man who presented with renal impairment and hypertension. Invasive selective renal angiography indicated severe stenosis in the proximal portion of the inferior left renal arteries. Intravascular ultrasound demonstrated eccentric plaque with predominant low-density plaque with calcification as the culprit. Percutaneous transluminal renal angioplasty with stent implantation of the left renal artery was performed. Nonobstructive angioscopy demonstrated a grade 3 yellow culprit plaque at the proximal end of the stent, and grade 2 and grade 1 yellow plaques as the culprit plaques at the middle and distal portions of the artery, respectively. <Learning objective: Atherosclerotic renal artery stenosis characterized by lipid-rich plaque and yellow plaque was diagnosed by intravascular imaging, such as intravascular ultrasound and angioscopy. As the stenosis was hemodynamically significant, percutaneous transluminal renal angioplasty was successfully performed. Nonobstructive angioscopy may be potentially applied for monitoring of transluminal ablation of the renal artery sympathetic nerves during drug-resistant hypertension.>.

Keywords: Computed tomography angiography; Intravascular ultrasound; Nonobstructive angioscopy; Renal artery stenosis; Yellow plaque.

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Figures

Fig. 1
Fig. 1
(A) Volume rendering image of the left renal artery. Two left renal arteries originate from the abdominal aorta and inferior and superior poles of the kidney. (B) Curved multiplanar reformation image of the left inferior renal artery. Severe stenosis in the proximal portion of the left inferior renal artery is shown (arrow). (C) Cross-sectional grayscale images of the left inferior renal artery at 1-mm intervals. The culprit is indicated (arrow). (D) Plaque Maps of the left inferior renal artery at 1-mm intervals. At the site of severe stenosis, noncalcified plaques averaged 22 Hounsfield Units (HU) and 154 HU (arrows).
Fig. 2
Fig. 2
Invasive selective renal angiographies of the left inferior renal artery before (A) and after (B) percutaneous transluminal renal angioplasty. Angiographically, approximately 90% stenosis was found in the proximal portion of the inferior left renal arteries (arrow).
Fig. 3
Fig. 3
Intravascular ultrasound image (A) of the culprit and Plaque Map of the corresponding image (B). Media or adventitia do not show thickening.
Fig. 4
Fig. 4
Nonobstructive angioscopy images of the left inferior renal artery. Grade 3 yellow plaque behind the proximal end of the stent (A). Grade 2 and grade 1 yellow plaques at the middle (B) and distal (C) portions of the artery, respectively.
See this image and copyright information in PMC

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