Utility of coaxial technique for renal angioplasty in patients with a difficult-to-cross stenosis

Abstract.

The aim of this study was to evaluate the feasibility of coaxial approach in difficult-to-cross lesions in patients with failed percutaneous transluminal renal angioplasty by conventional over-the-wire exchange technique. Twelve stenoses in 10 patients (six women and four men; age range 19 ± 7 years) with uncontrolled hypertension were treated by this method. The stenosis was caused by nonspecific aortoarteritis in 8 patients and fibromuscular dysplasia in 2 patients. It was ostial in seven and post-ostial in five vessels. Conventional exchange technique was unsuccessful in all of them. All procedures were done by femoral route. Technical success was seen in 11 (92 %), without complication. The stenosis improved from 90 ± 2.1 % (range 80–100 %) to 6 ± 7 % (range 0–20 %), blood pressure decreased from 198 ± 12.3 mm Hg (range 180–220 mm Hg)/130 ± 6.7 mm Hg (range 120–140 mm Hg) to 119 ± 5.7 mm Hg (range 110–130 mm Hg)/83 ± 3.9 mm Hg (range 80–90 mm Hg), and number of drug treatments for hypertension fell from 3.6 ± 0.52 (range 3–4) to 1 ± 0.94 (range 0–3; p < 0.01). Percutaneous transluminal renal angioplasty resulted in “cure” in 3 patients and “improvement” in 7 patients. Follow-up period was 3–21 months (mean 6.4 months). No restenosis was detected. Coaxial approach is safe and effective in treating difficult-to-cross lesions in which renal angioplasty by conventional exchange technique is unsuccessful.