Selective Coil Embolization of a Distal Segmental Renal Artery Lesion Causing Renovascular Hypertension

Antihypertensive therapy was initiated early and progressively escalated without clinical effect, prompting hospital admission.Her medical history included heterozygous factor V Leiden mutation, prior deep venous thrombosis, and catheter ablation in 2021 for right ventricular outflow tract ventricular ectopy and atrioventricular nodal re-entry tachycardia.No sustained arrhythmia or atrial fibrillation had been documented.Initial evaluation prioritized neurological causes.Noncontrast CT brain, brain MRI, and MR venography were normal.Due to persistent flank pain, contrast-enhanced CT angiography of the abdomen was performed, demonstrating a wedge-shaped cortical perfusion defect in the right kidney consistent with segmental renal infarction (Fig. 1), along with a focal distal segmental renal artery lesion with luminal irregularity suggestive of stenosis and/or dissection (Fig. 2).There was no evidence of generalized atherosclerosis or fibromuscular dysplasia.After identification of renal infarction, potential embolic and inflammatory causes were systematically evaluated.Continuous telemetry showed sinus rhythm without atrial fibrillation or sustained arrhythmia, and transthoracic echocardiography revealed no intracardiac thrombus.Laboratory testing demonstrated preserved renal function, minimal inflammatory response, and negative autoimmune serology including ANA and ANCA.These findings made cardioembolic, inflammatory, and systemic etiologies unlikely.The patient was treated with anticoagulation and multidrug antihypertensive therapy, including a renin-angiotensin system inhibitor, calcium channel blocker, thiazide diuretic, and mineralocorticoid receptor antagonist.Despite this, blood pressure remained poorly controlled and flank pain persisted.