• Images in cardiology

Although percutaneous renal angioplasty has been extensively used for fibromuscular or atherosclerotic renovascular hypertension, few cases have been reported in patients with aortic dissection. We describe stent angioplasty for severe stenosis of the right renal artery in a patient with a Stanford type B aortic dissection.

A 71 year old woman, who had suffered from hypertension for 30 years, consulted our hospital because of an acute onset of sharp back pain. Computed tomography showed a persistent false lumen originating from the descending thoracic aorta with termination at the right renal artery, indicating an acute aortic dissection, Stanford type B. After hospitalisation her blood pressure was difficult to control such that her systolic blood pressure frequently exceeded 180 mm Hg, in spite of the intravenous administration of nicardipine. Additionally, her serum creatinine developed from 8 g/m³ up to 31 g/m³, and her renin activity was elevated from 0.428 μg/m³/s up to 2.636 μg/m³/s, within 2 weeks. From these observations, we suggested that the patient’s hypertension was caused by stenosis of the renal artery induced by aortic dissection. Digital subtraction angiography (upper panel) and percutaneous renal angiography (lower panel) confirmed stenosis of the right renal artery, which was compressed by the false aortic channel. Therefore, percutaneous renal stent angioplasty was performed on the right renal artery. After stenting, the patient’s blood pressure returned to baseline.