In Reply to: Case 997_09 -- Renal artery stenosis posted by Editor on September 16, 1997 at 10:54:43:
This is obviously a very difficult case due to the anatomic configuration and the presence of a single kidney. A lot can go wrong in renal angioplasty/stenting (see M&M Ashville cases - new on the net) and I would approach this case with the utmost caution. I agree that surgery is not a good option for this patient because there is no normal renal artery between the lesion and the trifurcation. This patient needs treatment, no question. Balloon angioplasty is the way to start. I like Scott's suggestion of a guiding catheter and 2 simultaneous balloons. You could also do it with a one 7mmX2 cm balloon and 2 safety wires in the other arteries. If the result is not satisfactory you can deploy a short (P1007) stent with very precise positioning. We had a similar case in which a short Palmaz was deployed with an excellent result. I would try and not extend the stent into one of the branches.