Renal Artery Fibromuscular Dysplasia

50 years old female with a history of admission to the North Suburban Medical Center ER with severe headaches and chest pains. BP 220/120. Patient had normal CT head, normal stress test and normal cardiac cath.

Right renal angiography shown on (Image 1) reveals severe fibromuscular dysplasia (FMD).

Image 1. Right Renal Angiography

IVUS showed severe webbing of the right renal artery related to FMD (Image 2)

Image 2. Intravascular Ultrasound

FFR was done to see the pressure gradient across the FMD (Image 3). Interesting to note that there is significant systolic differential and no diastolic differential. (RED is proximal right renal artery pressure. YELLOW is distal right renal artery pressure)

Image 3. Fractional Flow Reserve

PTA performed with 6.0x40 mm Chocolate balloon from Medtronic. (Image 4)

Image 4. Chocolate PTA Balloon Catheter

Post PTA angiography showed great improvement in FMD (Image 5)

Image 5. Post PTA Angiography.

Post PTA: complete resolution of systolic pressure gradient noted on FFR. (Image 6).

Image 6. Right Renal FFR post PTA

Post Procedure Day #1 :

Patient describes that her symptoms resolved with a normal BP 110/55.

Conclusion: FMD of renal arteries that may cause malignant hypertension must be treated if there is more than 10% pressure difference across the FMD. Chocolate is a useful tool for PTA in renal arteries in the setting of FMD.

Reference:

- Fibromuscular Dysplasia Society Of America

- CathLabDigest Renal Artery Fibromuscular Dysplasia