Percutaneous transluminal angioplasty in renal artery fibromuscular dysplasia with intravascular imaging HTML

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

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

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Heading: Case reports

UDC: 10.24022/1997-3187-2018-12-4-383-391
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

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

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.

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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, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery