Renal Artery Fibromuscular Dysplasia
Updated: Oct 28, 2019
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).
IVUS showed severe webbing of the right renal artery related to FMD (Image 2)
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)
PTA performed with 6.0x40 mm Chocolate balloon from Medtronic. (Image 4)
Post PTA angiography showed great improvement in FMD (Image 5)
Post PTA: complete resolution of systolic pressure gradient noted on FFR. (Image 6).
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.