Percutaneous transluminal angioplasty in renalartery fibromuscular dysplasia with intravascularimaging

Authors: Bockeria O.L., Petrosyan K.V., Grigor’ev V.S., Koasari A.K.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

For correspondence:  Sign in or register.

Type:  Case reports


DOI: https://doi.org/10.24022/1997-3187-2018-12-4-383-391

For citation: Bockeria O.L., Petrosyan K.V., Grigor’ev V.S., Koasari A.K. Percutaneous transluminal angioplasty in renal artery fibromuscular dysplasia with intravascular imaging. Creative Cardiology. 2018; 12 (4): 383–91 (in Russ.). DOI: 10.24022/1997-3187-2018-12-4-383-391.

Received / Accepted:  11.11.2018/09.12.2018

Keywords: percutaneous transluminal angioplasty secondary arterial hypertension fibromuscular dysplasia renal artery stenosis optical coherence tomography

Download
Full text:  

 

Abstract

Renal artery (RA) fibromuscular dysplasia (FMD) is a rare cause of secondary arterial hypertension and is documented in less than 1–2% of hypertensive patients. RAFMD is predominantly presented in 25–50 year old women with multifocal “string of beads” lesions due to medial (80%) or perimedial (10–15%) dysplasia. Percutaneous transluminal angioplasty (PTA) without stent placement is a choice for FMD treatment. Patient 30 years old female has a long history of resistant arterial hypertension up to 220/120 mm Hg that was previously associated with preeclampsia during 3 pregnancies in last 4 years and which didn’t resolve after last miscarriage. Multispiral computed tomography has shown stenosis of the left renal artery. Fibromuscular dysplasia (FMD) was most likely diagnosis but patient was presented with components of metabolic syndrome, such as previously mentioned excess bodyweight, arterial hypertension, impaired glucose tolerance, dyslipidemia, so it was decided to perform optical coherence tomography (OCT) before endovascular treatment to evaluate etiology of the lesion. OCT has demonstrated FMD with stenosis on two levels due to medial thickness. Effective PTA was performed with good angiographic and OCT results without any signs of dissection. Arterial pressure was stable at 120/80 mm Hg level without any medication for 4 months of follow-up. FMD is a rare cause of secondary arterial hypertension and in its turn unilateral focal stenosis due to medial hyperplasia is a very rare type of FMD. Presented case allow to regard OCT as an important tool for differential diagnosis of the lesion etiology, estimation of the FMD morphology and control of the endovascular treatment results. PTA proved its efficacy and safety for treatment of RAFMD lesions in mid-term follow-up.

References

  1. Olin J.W., Gornik H.L., Bacharach J.M., Biller J., Fine L.J., Gray B.H. et al. Fibromuscular dysplasia: State of the science and critical unanswered questions: A scientific statement from the american heart association. Circulation. 2014; 129 (9): 1048–78. DOI: 10.1161/01.cir.0000442577.96802.8c
  2. Aboyans V., Ricco J.B., Bartelink M.E.L., Björck M., Brodmann M., Cohnert T. et al. 2017 ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur. Heart J. 2017; 39 (9): 763–816. DOI: 10.1093/eurheartj/ehx095
  3. Slovut D.P., Olin J.W. Fibromuscular dysplasia. N. Engl. J. Med. 2004; 350 (18): 1862–71. DOI: 10.1056/NEJMra032393
  4. Saw J., Poulter R., Fung A. Intracoronary imaging of coronary fibromuscular dysplasia with OCT and IVUS. Catheter. Cardiovasc. Interv. 2013; 82 (7): 879–83. DOI: 10.1002/ccd.24640
  5. Bockeria L.A., Gudkova R.G., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V. Cardiovascular surgery – 2016. Diseases and congenital anomalies of the circulatory system. Moscow; 2017: 9–45 (in Russ.).
  6. Alekyan B.G., Grigor’yan A.M., Staferov A.V. Endovascular diagnostics and treatment in the Russian Federation (2016). Russian Journal of Endovascular Surgery. 2017; 4 (2): 75–92 (in Russ.). DOI: 10.24183/2409-4080-2017-4-2-75-927
  7. Olin J.W., Froehlich J., Gu X., Bacharach J.M., Eagle K., Gray B.H. et al. The United States registry for fibromuscular dysplasia: results in the first 447 patients. Circulation. 2012; 125 (25): 3182–90. DOI: 10.1161/CIRCULATIONAHA.112.091223
  8. Cragg A.H., Smith T.P., Thompson B.H., Maroney T.P., Stanson A.W., Shaw G.T. et al. Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up. Radiology. 1989; 172 (1): 145–7. DOI: 10.1148/radiology.172.1.2662248
  9. Federal State Statistics Service (ROSSTAT). The population of the Russian Federation by sex and age (statistical bulletin). Moscow: ROSSTAT; 2017 (in Russ.).
  10. Sharma A.M., Kline B. The United States registry for fibromuscular dysplasia: new findings and breaking myths. Tech. Vasc. Interv. Radiol. 2014; 17 (4): 258–63. DOI: 10.1053/j.tvir.2014.11.007
  11. Mizutani K., Itoh A., Sugioka K., Komatsu R., Naruko T., Yoshiyama M. Intravascular findings of fibromuscular dysplasia on optical coherence tomography. J. Cardiol. Cases. 2015; 12 (2): 39–42. DOI: 10.1016/j.jccase.2015.03.009
  12. Mounier-Vehier C., Lions C., Jaboureck O., Devos P., Haulon S., Wibaux M. et al. Parenchymal consequences of fibromuscular dysplasia renal artery stenosis. Am. J. Kidney Dis. 2002; 40 (6): 1138–45. DOI: 10.1053/ajkd.2002.36855
  13. Trinquart L., Mounier-Vehier C., Sapoval M., Gagnon N., Plouin P.F. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension. 2010; 56 (3): 525–32. DOI: 10.1161/HYPERTENSIONAHA.110.152918
  14. Bonelli F.S., McKusick M.A., Textor S.C., Kos P.B., Stanson A.W., Johnson C.M. et al. Renal artery angioplasty: technical results and clinical outcome in 320 patients. Mayo Clin. Proc. 1995; 70 (11): 1041–52. DOI: 10.1016/S0025-6196(11)64439-X
  15. Zeller T., Frank U., Müller C., Bürgelin K., Schwarzwälder U., Sinn L. et al. Technological advances in the design of catheters and devices used in renal artery interventions: impact on complications. J. Endovasc. Ther. 2003; 10 (5): 1006–14. DOI: 10.1177/152660280301000526
  16. Shinke T. Editorial: Optical coherence tomography in endovascular intervention for renal artery stenosis. J. Cardiol. Cases. 2015; 12 (2); 43–4. DOI: 10.1016/j.jccase.2015.06.001
  17. Saw J., Bezerra H., Gornik H.L., Machan L., Mancini G.B. Angiographic and intracoronary manifestations of coronary fibromuscular dysplasia. Circulation. 2016; 133 (16): 1548–59. DOI: 10.1161/CIRCULATIONAHA.115.020282
  18. Garcia-Guimaraes M., Bastante T., Cuesta J., Rivero F., Navarrete G., Alvarado T. et al. Multifaceted presentation of recurrent spontaneous coronary artery dissection. Circ. Cardiovasc. Interv. 2017; 10 (2): e004696. DOI: 10.1161/CIRCINTERVENTIONS.116.004696
  19. Desai H., Hsi D., George J.C. Treatment of fibromuscular dysplasia of the renal artery with cryoplasty. Vasc. Dis. Manag. 2013; 10 (5): 86–8.
  20. Sanchez-Recalde A., Moreno R., Jimenez-Valero S. Renal artery fibromuscular dysplasia: in vivo optical coherence tomography insights. Eur. Heart J. 2014; 35 (14): 931. DOI: 10.1093/eurheartj/eht355
  21. Prasad A., Zafar N., Mahmud E. Assessment of renal artery fibromuscular dysplasia: angiography, intravascular ultrasound (with virtual histology), and pressure wire measurements. Catheter. Cardiovasc. Interv. 2009; 74 (2): 260–4. DOI: 10.1002/ccd.21968
  22. Suh Y.L., Chi J.G., Roh J.R. Primary intimal fibroplasia of the renal artery. J. Korean Med. Sci. 1988; 3 (1): 35–9. DOI: 10.3346/jkms.1988.3.1.35

About Authors

  • Ol’ga L. Bockeria, Corresponding Member of Russian Academy of Sciences, Dr Med. Sc., Professor, Chief Researcher; orcid.org/0000-0002-7711-8520
  • Karen V. Petrosyan, Cand. Med. Sc., Head of Department, orcid.org/0000-0002-3370-0295;
  • Viktor S. Grigor’ev, Postgraduate, Specialist in Endovascular Diagnosis and Treatment, orcid.org/0000-0002-1456-4697;
  • Anton K. Koasari, Cand. Med. Sc., Cardiovascular Surgeon, orcid.org/0000-0003-3205-4700.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery