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Clinical Images
Renal V-Stenting
Steven Vercauteren, MD, Benny Drieghe, MD, Bernard De Bruyne, MD, PhD
February 2007
An 83-year-old male with a recent history of arterial hypertension and progressive renal failure was referred for an elective percutaneous intervention of a bilateral renal artery stenosis, i.e., an ostial lesion of a left inferior renal polar artery and an ostial stenosis of a side branch of the right renal artery (Panel A). A 6 Fr RDC guiding catheter and a Middleweight guidewire (Guidant Corp., Indianapolis, Indiana) were used to successfully cross the stenosis of the left inferior polar artery. An excellent angiographic result was obtained after direct stenting with a 4.0 x 19 mm Express™ Vascular SD (Boston Scientific Corp., Natick, Massachusetts). Next, the same guiding catheter and guidewire were used to cross the stenosis in the side branch of the right renal artery. The stenosis was dilated up to 12 atm with the balloon. Control angiography revealed a significant dissection of the side branch with impairment of blood flow (Panel B). Hence, all material was withdrawn and an 8 Fr internal mammary catheter was used to engage the ostium of the right renal artery. Middleweight guidewires were placed in the main renal artery and the side branch. Next, 2 identical stents (RX Herculink® Plus 5.0 x 18 mm, Guidant) were simultaneously deployed side-by-side (“V”-stenting) in the main and the side branch (Panel C). The final angiographic result was excellent (Panel D). This case illustrates that techniques used for bifurcation lesions in the coronary circulation, i.e., “V-stenting” can be efficiently used in renal interventions.
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