ABSTRACT
Renal artery disease is one of the significant factors that lead to compromise renal function and/or aggravate hypertension in the elderly population. Since the non-surgical treatment of renal artery stenosis, percutaneous transluminal renal angioplasty, is available, it is possible to cure the decreased renal function and exacerbated hypertension. However, bilateral renal artery occlusion (BRAO) that brings about anuria and azotemia is rare. In this communication, we'd like to describe a patient who developed acute renal failure due to BRAO. His renal function was completely recovered after successful implantation of stents into both renal arteries. We are unaware of prior reports documenting the beneficial effect of a distal embolic protection device, the PercuSurge GuardWire system (Medtronic, Minneapolis, MN, USA), in a clinical setting as described here. The GuardWire arm, a device for transient distal balloon occlusion during angioplasty or stent placement, allows recovery of any liberated plaque by aspiration before restoration of antegrade flow, and thereby performs a double service. We'd like to strongly recommend that stent implantation with adjunctive distal protection is essential to obtain a complete restoration of distal blood flow although there is sufficient collateral blood flow in elderly patients with BRAO and azotemia.