Percutaneous treatment of chronic renal artery occlusions in pediatric nephrovascular hypertension. A case series

Background Percutaneous treatment of renal artery stenosis through renal artery angioplasty (PTRA) is widely recognized as effective and safe, even in pediatric patients affected by neprhrovascular hypertension (NVH). In some rare cases, complete renal artery occlusion (RAO) occurs. Currently, there is limited data on the efficacy and safety of PTRA for RAO treatment, especially in pediatric patients, with only isolated cases described in the literature. Purpose to evaluate the clinical effect and safety of PTRA for the treatment of RAO in pediatric patients based on the description of six patient case series. Methods Two males and four females (mean age 12.3 ± 5.3 years) affected by NVH associated with RAO, treated between 2016 and 2025, were included in the study. We assessed the following PTRA-induced changes as endpoints at 12 months: 1) Systolic blood pressure (SBP) and diastolic blood pressure (DBP). 2) Number of antihypertensive drugs used. 3)Left ventricular mass indexed (LVMI). 4) Serum creatinine, 5) Renal ultrasound and Doppler parameters: bipolar diameter (cm), acceleration time (AT, msec), resistive index (RI), 6) any adverse events related to the procedure during the entire follow-up. PTRA was performed via a transradial arterial approach and was successful in restoring the patency of the renal artery in all subjects. In four cases, a stent was placed. Data were analyzed using the Student’s t-test for paired data. Results 1) SBP and DBP values decreased by 13.3 ± 10.9 mmHg (p < 0.05) and 20.6 ± 6.4 mmHg (p < 0.01), respectively. 2) The average number of drugs taken decreased from 2.5 ± 1.2 to 0.6 ± 0.7 (p < 0.05). 3) LVMI decreased by 25 ± 10.9 g/m².7 (p < 0.01). 4) Serum creatinine did not change. 5) Diameter of the treated kidney increased by 0.75 ± 0.74 cm (p < 0.05), with a trend observed in all patients. AT decreased in all patients, with an average reduction of 81.6 ± 27.7 msec (p < 0.01), while RI remained unchanged. 6) No PTRA related adverse events occurred. Conclusions Our case series on PTRA for the treatment of RAO in pediatric patients with NVH, although limited in number, is currently the largest in the literature and demonstrates that it is feasible, effective, and safe. After 12 months, improvement of kindney perfusion echo-Doppler parameters and reduction in both systolic and diastolic blood pressure, left ventricular mass, and, importantly, number of antihypertensive drugs needed for optimal blood pressure control were evident in all patients.