PERCUTANEOUS CUTTING BALLOON ANGIOPLASTY FOR TREATMENT OF RESISTANT RENAL ARTERY STENOSIS IN PEDIATRIC PATIENTS

Abstract

Objective: Percutaneous transluminal renal angioplasty (PTRA) without stenting is the recommended treatment for hypertensive children with renal artery stenosis (RAS). However not infrequently RAS is resistant to PTRA or recurs after the procedure. To circumvent PTRA limitations percutaneous cutting balloon angioplasty (PCBA) has been used occasionally but caution is warranted because of the risk of rupture or dissection of renal artery. However the technical improvements in PCBA prompted us to exploit this procedure in children with severe hypertension and RAS resistant to PTRA. Design and method: Thirteen children (10 males, mean age 7.9 ± 3.3 y at operation) with resistant RAS (bilateral in 5) underwent PCBA. In 10 patients (pts) RAS was due to fibromuscular dysplasia, in 2 due to NF1 and in 1 to William's Syndrome. In 3 pts in addition to PCBA stenting of the aorta (1pt) and of RAS (3 pts) was also applied. Office blood pressure (BP), 24 hours ambulatory pressure monitoring (ABPM) (4/13pts), renal function and ultrasound (US) of renal arteries were evaluated before and after PCBA after a mean follow up of 21 ± 17.4 months. Results: PCBA achieved dilation of RAS in all cases. In one single case partial renal artery dissection occurred that did not require stent application. At follow-up no restenosis was found at US investigation in the 15 lesions who didn’t need stenting of RAS and in 1/3 stented RAS. Hypertension was cured in 7 pts and improved in the remaining 6 pts. After PCBA mean office systolic and diastolic BP (SBP and DBP mmHg) were reduced respectively from 141 ± 19 to 122 ± 12 and from 87 ± 10.to 69 ± 11 (p < 0.05 for both). With ABPM, SBP and DBP decreased respectively from 145 ± 3 to 130 ± 3 and from 88 ± 14 to 79 ± 16 (p < 0.05 for both). The antihypertensive agents assumed by pts with improved BP decreased from a mean of 2.7 to 0.6 per day. No significant changes were found in renal function after PCBA. Conclusions: In our experience PCBA appears a safe and effective treatment of RAS resistant to PTRA.