The Flash to the Rescue

Physician Voices

Submitted on Wed, 03/04/2015 - 11:39

Patient History

An 83-year-old patient presents with chronic angina and difficult to control hypertension. In spite of 3 different antihypertensive medications, her blood pressure is consistently over 180/90.  Noninvasive testing suggested right renal artery stenosis.

Methods

We went in the right groin and used a Jr4 diagnostic catheter for a renal angiogram. The right renal artery was 80% stenosed (Video 1).  We passed a .014" Cougar wire (Medtronic) and predilated the stenosis with a 3.5 AngioScore balloon (Spectranetics,).  We then passed a 5.0mm x 18mm Herculink stent (Abbott) (Video 2).  We then passed the Flash Ostial balloon system (Cardinal Health) 5.0mm x 14mm.  We passed the middle marker of the balloon 2mm inside of the stent ostium (Video 3).  The proximal Flash balloon was dilated twice to large diameter (Video 4).  The resultant residual was minimal and there was excellent proximal flaring of the stent (Videos 5 and 6). 

Discussion

Renal artery stenting is still controversial; however, it is still utilized in patients with resistant hypertension.  Resistant lesions, as well as ostial renal stenosis, respond well to focal treatment with the AngioScore balloon as well as the Flash Ostial balloon system.

Conclusion

This patient responded well to the Ostial balloon system with sufficient apposition of the stent.

LEGENDS

Video 1.  AP angiogram showing the right renal artery stenosis.

Video 2.  Stent in the stenosis after pre-dilation.

Video 3.  Dilation with the Flash Ostial balloon system.

Video 4.  Further balloon dilation with higher Ostial balloon inflation.

Video 5.  Fluoroscopy allows one to appreciate the flaring of the proximal stent.

Video 6.  Final angiographic result.