Renal Artery Stenting
as a Cure for Renovascular Hypertension
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As one of the most common conditions among men and women, hypertension can be a devastating disease to millions of people. If left untreated, it can lead to stroke, kidney failure and/or heart attack.
The causes of hypertension have not yet been found. Traditionally, it has been managed via a life-long combination of medications, special diets and exercise plans aimed at normalizing the blood pressure.
Yet for 3 percent to 5 percent of people with hypertension, there is an identifiable, treatable and curable cause, the most common of which is stenosis of the renal artery. Although this percentage is small, it translates into thousands of potentially curable patients.
The challenge lies in making an accurate diagnosis. No reliable screening method exists. Nuclear scans, such as a captopril renogram, offer lower than desirable sensitivity. Renal artery ultrasound may be effective, but only in the hands of a very skilled sonographer.
Signs that hypertension may be caused by renal artery stenosis include young age, no family history of hypertension, and hypertension that used to be well controlled but is now difficult to manage.
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Case
Study
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Patient: R.B., a 58-year-old male from Des Plaines History: Long-standing, moderately severe, but well-controlled hypertension treated with large doses of 3 antihypertensive drugs Symptoms: Severe, unremitting headaches and rapidly progressing hypertension Tests: Renal scan and renal angiography Diagnosis: Severe renovascular hypertension Treatment: Balloon angioplasty with stent insertion |
In the case of R.B., his personal physician, an internist, suspected a link between his patient’s worsening hypertension and his renal function. (See Case Study) A renal scan indicated decreased blood flow to the left kidney and renal angiography confirmed a discrete 90+ percent ostial renal artery stenosis. (See Figure 1.)
Figure
1:
Renal angiogram indicating decreased blood flow to the left kidney.
Once the diagnosis was confirmed, R.B. was presented with three options. The first option was additional medication, as long as it controlled his blood pressure and had minimal side effects. The second option was surgical repair of the renal artery, a major operation with a sub-optimal risk-benefit ratio. The third and chosen option was percutaneous stenting of the renal artery. Therefore, balloon angioplasty with deployment of a Palmaz stent was performed. (See Figure 2.) Experience has shown that, in the case of renal arteries, balloon angioplasty used by itself has a high restenosis rate.
Figure
2:
Angiogram of stented renal artery.
The procedure was performed in the cath lab and the patient went home the next day. When R.B. returned one month later, his blood pressure was 130/80 and he was only taking a low dose of a single antihypertensive drug. He is currently being followed by his personal physician.
Minimally invasive procedures, such as renal arterial stenting, offer more permanent relief to patients at a physical and financial cost that is far less than a lifelong prescription for medications or a surgical procedure. At a time when physicians are being asked to balance high-quality care with cost-effective management, these types of procedures are an exciting progression in contemporary medicine.
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