Key result
IVUS and pressure wire exclude severe stenosis, enabling successful RSD for refractory hypertension.
Case Report (n=1)
Intravascular imaging and functional assessment can guide the management of patients with refractory hypertension and renal artery atherosclerotic disease being considered for renal sympathetic denervation.
May guide stenosis exclusion before renal denervation in refractory hypertension; hypothesis-generating case report requiring prospective validation.
BACKGROUND: Renal sympathetic denervation (RSD) is emerging as a new therapeutic option for patients with severe hypertension refractory to medical therapy. The presence of a renal artery stenosis may be both a cause of secondary hypertension and a contraindication to RSD if a renal artery stent is implanted; therefore, the definition of the functional importance of a renal artery stenosis in a patient with refractory hypertension is crucial. METHODS: We describe the imaging and functional intravascular assessment of an angiographically severe stenosis of the renal artery in a patient with severe refractory hypertension, by means of intravascular ultrasound (IVUS), and measurement of the translesional pressure gradient with a pressure wire. RESULTS: Pressure wire examination excluded any severity of the stenosis, and IVUS showed the presence of a dissected plaque that resolved spontaneously after 3 months of intensive medical therapy and high-dose statin. Subsequently the patient was treated with RSD, achieving a significant effect on blood pressure control. CONCLUSIONS: Intravascular imaging and functional assessment of renal artery anatomy in patients with atherosclerotic disease may prove particularly suited to patients with refractory hypertension and multilevel vascular disease who are considered for endovascular therapies, either renal artery stenting or RSD.
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Ribichini et al. (2013) conducted a case report in severe refractory hypertension (n=1). Intravascular ultrasound (IVUS) and pressure wire assessment was evaluated on blood pressure control. Intravascular ultrasound and pressure wire assessment excluded severe stenosis in a patient with refractory hypertension, allowing successful treatment with renal sympathetic denervation.
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