Assessment and treatment of renal lesions. Several technologies from the cardiac arena can help refine the definition of physiologically relevant RAS and tailor revascularization for those patients with the greatest likelihood of benefit.
A 58-year-old woman presented with resistant hypertension. Despite using 5 antihypertensive agents, her serum creatinine had increased from 1.0 mg/dL to 2.0 mg/dL over the preceding year. Her hypertension had been well controlled on 2 agents 2 years earlier.
Bilateral elevated renal artery velocities were identified on ultrasound with normal-sized renal arteries. After angiography, pressure wire assessment, and intravascular ultrasound confirmed physiologically important, high-grade stenoses bilaterally, both renal arteries were dilated (this radiograph shows the opened left renal artery), and blood pressure control began to improve within 24 hours.
At follow-up 1 month later, the woman had returned to controlled hypertension using 2 pharmacologic agents, and her creatinine level had normalized.