In Reply to: Case 997_09 -- Renal artery stenosis posted by Editor on September 16, 1997 at 10:54:43:
I would do PTA, especially in light of the recent MI. Extreme care is necessary to avoid rupture of one of the distal branches; only the nose of the balloon should be across the lesion. It is very, very helpful in this type of case to do the PTA through a long 7fr sheath, so that injections can be made to help with the necessary precise positioning of the balloon. This will also facilitate faster placement of a stent should one become necessary. (Your lesion is concentric and non-ostial; you probably won't need a stent, but....)
I might or might not use safeties; you need an oblique, probably with CC angulation, to lay out the anatomy a little better.
As for the solitary kidney; I do them all the time for salvage of renal function, and am much less nervous about them since the coming of Palmaz stents. The procedure is no more or less dangerous per se, the downside of failing is somewhat larger. That's why they pay us the big bucks!!!