Post-stenotic renal artery dilatation – the smoking gun of a case of renal fibromuscular dysplasia induced secondary hypertension

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Secondary hypertension due to renal artery stenosis (fibromuscular dysplasia) (n=1). Intervention: Renal artery stenting (covered stent). Primary outcome: Blood pressure normalization.

Nelson F. Gomes Oliveira; Isabel Cássio

doi:10.48750/acv.712

January 9, 2026Angiologia e Cirurgia VascularOpen Access

Post-stenotic renal artery dilatation – the smoking gun of a case of renal fibromuscular dysplasia induced secondary hypertension

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Key result

Renal artery stenting normalizes blood pressure and eliminates all antihypertensive medications at 9 months.

n=1

Why the study?

Renal artery stenosis is a leading cause of secondary hypertension, with diagnostic challenges in identifying fibromuscular dysplasia-related stenosis.

Key Points

To describe the diagnosis and endovascular management of renovascular secondary hypertension caused by fibromuscular dysplasia that was initially missed on computed tomography angiography.
Clinical and diagnostic evaluation of a 41-year-old male presenting with erythrocytosis and worsening hypertension refractory to dual antihypertensive therapy.
Diagnostic reassessment using duplex ultrasound, computed tomography angiography (CTA), and digital subtraction angiography (DSA).
Endovascular revascularization using a 7×27mm covered stent following translesional pressure gradient measurement, with clinical follow-up at 9 months.
Imaging reappraisal and digital subtraction angiography revealed a right renal artery mid-section dilatation located between 2 focal stenoses, yielding a translesional pressure gradient of 107mmHg.
Deployment of a 7×27mm covered stent achieved a good angiographic result.
At 9 months after intervention, blood pressure normalized and antihypertensive medications were completely withdrawn.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 41-year-old male with refractory secondary hypertension and erythrocytosis due to fibromuscular dysplasia-induced renal artery stenosis followed for 9 months after treatment.

I

Intervention

Renal artery primary stent angioplasty with a 7x27mm balloon-expandable covered stent (Bentley Begraft Peripheral) without filter protection.

O

Outcome

Blood pressure normalization and withdrawal of antihypertensive medicationssurrogate

Limitations

Single case report which limits generalizability.
Uncertainty around the exact etiology of the stenosis despite fibromuscular dysplasia being suspected.
Uncertain long-term benefit and lack of robust data supporting the use of covered over bare-metal stents for this specific complex lesion.

Implication

A high index of clinical suspicion and thorough imaging evaluation can identify unusual cases of renal fibromuscular dysplasia, which can be successfully treated with covered stents to resolve secondary hypertension.

Abstract

INTRODUCTION: Renal artery stenosis is a leading cause of secondary hypertension, with atherosclerosis and fibromuscular dysplasia as the main causes. CASE REPORT: A 41-year-old male developed progressive worsening of high blood pressure over the previous 5 years, along with erythrocytosis, despite compliance with dual antihypertensive therapy. Duplex ultrasound suggested the presence of a right renal artery stenosis. Subsequent tomography angiography (CTA) failed to report a significant stenosis. However, upon imaging reappraisal, the presence of a mid-section dilatation in the right renal artery was noted. Digital subtraction angiography confirmed the dilatation between 2 focal stenoses, which were not identifiable on CTA, suggestive of fibromuscular dysplasia. A translesional pressure gradient of 107mmHg107mmHg was determined. Renal artery stenting was performed with a 7×27mm7×27mm covered stent with good angiographic result. Nine months after intervention, blood pressure normalized, and antihypertensive medications were withdrawn. CONCLUSION: High clinical suspicion was key to adequately diagnose and manage this case of renovascular secondary hypertension.

Discussion

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Cite This Study

Oliveira et al. (2026) conducted a case report in Secondary hypertension due to renal artery stenosis (fibromuscular dysplasia) (n=1). Renal artery stenting (covered stent) was evaluated on Blood pressure normalization. Renal artery stenting completely normalized blood pressure and allowed for the withdrawal of all antihypertensive medications at 9 months post-intervention.

synapsesocial.com/papers/6ad0fd263afa093ea9ad028a https://doi.org/10.48750/acv.712

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Post-stenotic renal artery dilatation – the smoking gun of a case of renal fibromuscular dysplasia induced secondary hypertension

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Post-stenotic renal artery dilatation – the smoking gun of a case of renal fibromuscular dysplasia induced secondary hypertension

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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