J INVASIVE CARDIOL 2020;32(1):E9-E10.
Key words: cardiac imaging, optical coherence tomography, renal artery stenosis
A 20-year-old man presented with a severe headache and sudden-onset blurring of vision of 2-month duration. Fundus examination revealed hypertensive retinopathy in both eyes. His blood pressure was 190/120 mm Hg, for which amlodipine, telmisartan, and diuretics were started. Systemic examination was unremarkable. Routine serum biochemistry was normal; serum creatinine was 0.88 mg/dL and estimated glomerular filtration rate was 87 mL/min/1.73 m2. Ultrasound revealed small right kidney (5.8 x 3.4 cm) and normal-sized left kidney (9.4 x 4.3 cm). Computed tomography scan of the abdomen confirmed small right kidney and diffuse non-ostial narrowing of the right renal artery (Figure 1). Various serum tests for autoimmune and procoagulant work-up were negative. Echocardiogram was normal, with no evidence of thrombus. Selective angiogram confirmed 95% non-ostial narrowing of the proximal right renal artery with a double-lumen appearance (Figure 2A; Video 1). A 6 Fr multipurpose (MP-1) coronary guide catheter was used to selectively cannulate the right renal artery via left transbrachial approach. The lesion was crossed with a 3 g Miracle wire (Asahi Intecc) and dilated with a 2.5 x 15 mm balloon. Optical coherence tomography (OCT) revealed luminal narrowing and multiple intraluminal channels with a “honeycomb” or “Swiss cheese” appearance, suggestive of a recanalized thrombus (Figure 2C; Video 2). A 4 x 24 mm everolimus-eluting Synergy stent (Boston Scientific) was deployed and postdilated with a 5 x 8 mm non-compliant balloon at the proximal end (Figure 2B). Repeat OCT imaging revealed well-apposed stent with no residual stenosis or dissection (Figure 2D). At 1-month follow-up, his blood pressure was normal (120/77 mm Hg) on telmisartan.
The common cause of renal artery stenosis in young is fibromuscular dysplasia or Takayasu arteritis. Recanalized thrombus, on the other hand, is a rare cause for renal artery stenosis in young patients. OCT imaging confirmed the diagnosis and optimized the renal stenting results.
From the Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
The authors report that patient consent was provided for publication of the images used herein.
Manuscript accepted February 19, 2019.
Address for correspondence: Prof (Dr) Rajesh Vijayvergiya, MD, DM, FSCAI, FISES, FACC, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh – 160 012, India. Email email@example.com