Endovascular Treatment of Renal Artery StenosisClinical Indications (Procedures)AnatomyKidney anatomyEndovascular Treatment of Renal Artery StenosesAim of the treatment 1) Renovascular Hypertension 2) Renal InsufficiencyRenovascular Hypertension 5% of all hypertensive patients Due to atherosclerosis or FMD Diagnosed after Surgical follow-up or PTRA. PTRA does not cure Essential Hypertension Renal Insufficiency Nephrosclerosis after RAS or occlusion PTRA is indicated to reverse or prevent the decline of kidney functions 8cm long kidney is the lower limit after which kidney function might be compromisedIndications for PTRA Failed medical therapy Reducing drug treatment Pressure gradient 10% More than 50% stenosis Assymmetrical loss of renal massEndovascular Treatment of Renal Artery Stenoses1) Treatment of artheriosclerotic ostial lesions (80%) dilatation + stenting2) Treatment of post ostial lesions dilatation (stenting if necessary)3) Treatment FMD dilatation (stenting if necessary)Post-ostial lesionFibro-Muscular DysplasiaFibro-Muscular DysplasiaRestenosis after stenting Recent studies have indicated rates are between 10-20% (much better than the 30% with just PTA).Treatment Options Medical Treatment PTA with Stenting Surgery Dialysis: Renal Function never get betterGold standard treatment today Medical treatment ACE inhibitors and a new class of Angiotensin receptor blockers Endovascular Options: PTA or Stenting ? 1999: Peter Van de Ven, randomized trial PTA vs Stenting in ostial lesion PTAStentingNumber of patients4243Primary patency rate29%75%Primary success rate57%88%Restenosis post-procedure48%14%LiteratureProduct Strategies 014” Cardiologist, Radiologists, Vasc Surgeons. Balloon: M3 Rx Stents: Corinthian IQ on M3 Wire, Stabilizer 7-8F Vista Brite Tip or IG 035 Radiologist who are used to traditional PTA balloons, More range in PTA balloons Balloons: P3, Opta Pro Stents: Genesis premounted on OPTA - PRO Wire 035, Jindo, Storq 8F Vista brite Tip or IGA new approach: .018 !A GOOD COMPROMISE ! Radiologist who are used to traditional PTA balloons, More range in PTA balloons Balloons: Slalom Stent: Genesis premounted on OPTA -PRO Wire 018, SV 6-7F Vista brite Tip or IGAdvantages of .014 systemsLess spasm with .014 wire Less wire length Smaller puncture site Stent protected by GC Good supportEndovascular Treatment of Renal Artery Stenoses Through the groin using 8F materialsCan be downsized to 7F using M3Emerald .035Emerald .035 + Pigtail Tempo 4-5F 65cmEmerald .035 + Renal Curve Tempo 4F 65cmEmerald .035 + Renal Curve Tempo 4F 65cmEmerald .035 + RDC Vista Brite Tip 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Opta ProEmerald .035 + RDC VBT 8F 55cm + Opta ProEmerald .035 + RDC VBT 8F 55cm + Opta ProEmerald .035 + RDC VBT 8F 55cmEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta ProEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta ProEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta ProEmerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta ProEmerald .035 + RDC VBT 8F 55cm + Corinthian IQEndovascular Treatment of Renal Artery Stenoses2) Through the groin using the new 6F materials.014 Stabilizer.014 Stabilizer + 6F Brite Tip Sheath 55cm.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F.014 Stabilizer + 6F BTS 55cm + M3.014 Stabilizer + 6F BTS 55cm + M3.014 Stabilizer + 6F BTS 55cm + Corinthian IQ on M3.014 Stabilizer + 6F BTS 55cm + Corinthian IQEndovascular Treatment of Renal Artery Stenoses3) Through a brachial accessTempo 4F MP + .014 StabilizerBrite Tip Sheath 6F 90cm + .014 StabilizerBrite Tip Sheath 6F 90cm + .014 StabilizerBrite Tip Sheath 6F 90cm + RDC Tempo 4F +.014 StabilizerBTS 6F 90cm +.014 StabilizerBTS 6F 90cm +.014 Stabilizer + M3BTS 6F 90cm +.014 Stabilizer + M3BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3Endovascular Treatment of Renal Artery StenosesProceduralPost procedureEndovascular Treatment of Renal Artery StenosesPre operativePost operative