ABSTRACT
Percutaneous transluminal renal angioplasty(PTRA) has become the treatment of choice for major renal artery stenosis. Nonetheless, about 10% of renal artery stenosis could not be properly dilated and 10-15% had a recurrence among the parients successfully dilated. Especially, PTRA in Takayasu's arteritis has technical diffculties due to the tough, noncompliant nature of the stenosis, which art difficult to cross and resist the respeated, prolonged balloon inflations. Intraluminal renal artery stent placement in unsuccessful balloon angioplasty and unsuitable lesions to PTRA may be an attractive approach to improve flow conditions. We report two cases of proximal renal artery stenosis caused by Takayasu's arteritis, who treated with intraluminal renal stenting(Palmaz-Schatz biliary stent). In both cases, clinical and angiographical improvement was achieved.
Subject(s)
Angioplasty, Balloon , Constriction, Pathologic , Recurrence , Renal Artery Obstruction , Renal Artery , Stents , Takayasu ArteritisABSTRACT
BACKGROUND: Coronary artery target lesion calcification may be an important determinant of the arterial response to catheter therapy for coronary arterial disease. The excimer laser coronary angioplasty(ELCA) has been reported to be a promising treatment for complex coronary artery disease. However, the effects of ELCA is not well known against the calcified target lesion. METHODS: To assess the arterial and plaque remodeling in calcified lesions after excimer laser coronary angioplasty, we used a comprehensive intravascular ultrasound(IVUS) imaging system(25MHz rotation transducer, 3.9 Fr monorail imaging sheath, motorized transducer pull back at 0.5mm/sec and quantification) to study 23 patients(1 left main, 10 LAD, 4 LCX, 6 RCA, 2 SVG) before and immediately after ELCA(the AIS 308nm XeCl excimer laser, pulse width >200nsec, pulse frequency 20Hz, energy density 35-65mJ/mm2). Paired before and after ELCA image slices were analysed ; and extermal elastic membrane, lumen, plaque+media(P+M) and calcium cross-sectional area(CSA) measured; and their differences after ELCA calculated. RESULTS: The IVUS results about the therapeutic effects of ELCA showed the enlargement of lumen CSA from 1.5+/-0.4 to 3.2+/-0.9mm2(p<0.001) and decreased of P+M CSA from 14.6+/-3.8 to 13.4+/-3.6mm2(p<0.001) without arterial expansion. The decrease of calcium CSA from 1.8+/-0.7 to 1.5+/-0.6mm2(p<0.001) and the formation of small, superficial fissures within the calcified plaque(15/23 lesions) were noted. The number of small fissures correlate with the calcium CSA significantly(r=0.61, p<0.001). CONCLUSION: The plaque and calcium ablation is the main effects of ELCA in calcified lesion, and the calcium ablation and fissure formation after ELCA may contribute to decrease the dissection and improve the success after ajunctive PTCA.
Subject(s)
Angioplasty , Calcium , Catheters , Coronary Artery Disease , Coronary Vessels , Lasers, Excimer , Membranes , Transducers , UltrasonographyABSTRACT
A 21-year-old woman found to be hypertensive was referred for hypertension. On examination, blood pressure was 170/110mmHg in the right arm, 160/100mmHg in left arm,and 120/70mmHg in legs. A grade 2/6 systolic ejection murmur was present at the left upper sternal border, and a chest x-ray revealed a rib notching on the inferior margin of 4th rib. Two-dimensional echocardiogram showed the coarctation of aorta beyound the origin of the left subclavian artery. Biplane TEE demonstrated a discrete narrowing of the descending aorta at the site of coarctation. The blood pressure was 169/86mmHg in ascending aorta and 118/84mmHg in descending aorta. Aortogram showed a localized coarcted aortic segment of 7mm in diameter and 5mm long just distal to the left subclavian artery. Balloon coarctation angioplasty was performed with 7F 30x15mm pediatric balloon dilatation catheter. Balloon position was confirmed on fluoroscopy by the hourglass appearance of the balloon inflation and thereafter, the balloon was inflated until the waist of the balloon disappeared. After procedure, a pull back pressure tracing across the coarctation of aorta revealed no pressure gradient between ascending and descending aorta with 141/90mmHg. Aortogram showed an increase in diameter of the coarctation of aorta to 18mm with aneurysmal formation. 3 months later, follow up aortogram showed no significant change in diameter of coarctation of aorts or aneurysmal formation. Nonsurgical balloon coarctation angioplasty appears to be an alternative therapy for the coarctation of aorta in adults.
Subject(s)
Adult , Female , Humans , Young Adult , Aneurysm , Angioplasty , Angioplasty, Balloon , Aorta , Aorta, Thoracic , Aortic Coarctation , Arm , Blood Pressure , Catheters , Dilatation , Fluoroscopy , Follow-Up Studies , Hypertension , Inflation, Economic , Leg , Ribs , Subclavian Artery , Systolic Murmurs , ThoraxABSTRACT
No abstract available.