In Reply to: Case 0300_01 --Renal Artery Occlusion: Thrombolysis with TPA posted by Editor on March 07, 19100 at 10:59:32:
Good questions without clear-cut answers. The reference you cited by Blum et al in 1993 painted a very dismal prognosis for improvement in renal function following thrombolysis. A limit of 90 minutes of ischemic time was suggested. This corresponds well with the experience in renal transplantation. However, we have definitely seen recovery of renal function after many days of ischemia. Non-occlusive emboli which permit distal flow and pre-existing renal artery disease associated with collateral vessel recruitment both probably prolong the ischemic time limit for successful intervention. If patient has solitary kidney or renal insufficiency, then I believe thrombolyis should be attempted. If the contralateral kidney maintains normal function the decision whether to intervene is more difficult. I would argue in favor of a therapeutic trial in the majority of these patients.
Placing uncovered stents across branch vessels (putting them in "stent jail") has not generally resulted in branch vessel occlusion.