ABSTRACT
Of the 21 lesions in the renal artery, 17 were de novo and 4 had in-stent restenosis. For renal angioplasty, CB 4-5 mm in diameter with an Atherotome length of 10-15 mm was passed through an 8-French coaxial guiding catheter or a 7-French sheath over 0.014-0.018-inch diameter, extrasupport guidewire. Femoral approach was used in 15 patients and a high-brachial approach in 3 patients with severe caudal angulation of renal artery. The balloon could be negotiated through stenosis with ease in all patients. In patients with de novo lesions inflation of the balloon at 6-8 atmospheres could eliminate “waste” on the CB in 14 of 17 (82.3%) lesions. Adjunctive balloon angioplasty to further enlarge the lumen was performed in 17 lesions using a 5-6-mm conventional balloon. The stenosis decreased from 87.5 ± 7.8% (mean ± SD) to 28.2 ± 9.3% (mean ± SD) after CB and further reduced to 14.2 ± 4.9% (p < 0.001) after further dilatation/stent implantation (Figure 9.2). There was no complication. Failure to abolish “waste” in CB in three patients could be due to the inability of the 0.127-mm working height of the blade to reach the dense fibrosis in the media through markedly thickened intima, which is often the pathology.13
Follow-up angiographic restudy performed after 6-24 months in 14 lesions showed restenosis in two patients (14.3%). Both of these underwent redilation.
