HYPERTENSIVE IRON MAN: WHEN STENTING THE RENAL ARTERIES IS A GOOD OPTION

Objective: Systemic atherosclerosis often results in renal artery stenosis, a well-recognized factor contributing to resistant hypertension and renal dysfunction, which increases the likelihood of cardiovascular events. Percutaneous transluminal renal angioplasty (PTRA) has been applied to address this issue. However, its efficacy in improving blood pressure control remains a subject of debate. Several studies suggest that PTRA can facilitate blood pressure management in patients with atherosclerotic renal artery stenosis, yet the overall benefits, particularly concerning long-term outcomes, are not conclusively established. This clinical case examines a patient with severe systemic atherosclerosis and uncontrolled hypertension who underwent angioplasty of both renal arteries, aiming to assess the procedure’s impact on blood pressure regulation and renal function. Design and method: A 68-year-old male with numerous risk factors (hypertension, dyslipidemia, diabetes mellitus, past smoker) and widespread severe atherosclerosis, presented with uncontrolled hypertension, HF and progressive renal dysfunction. His medical history dates back to 2002 when he suffered a myocardial infarction treated with pharmacological reperfusion (thrombolysis with streptokinase). Afterwards, structural and functional remodelling of the LV induced dilatation, severely reduced ejection fraction, aneurism formation with apical thrombus and non-sustained ventricular tachycardia. Interventions included coronary angioplasty with DES of the LCx artery and insertion of an ICD in primary prevention. Patient reported severe claudication, and sequential numerous angioplasties were performed on both lower limbs. Post-prandial abdominal pain guided to diagnosis of subocclusion of superior mesenteric artery treated with angioplasty. Results: The uncontrolled hypertension led to renal angiography which revealed a 90% stenosis in both renal arteries and angioplasty was performed. Post-procedural follow-up showed an improvement in blood pressure control, with a reduction of 25 mmHg in systolic BP and 10 mmHg in diastolic BP. Renal function, as assessed by serum creatinine levels, improved in the first month and remained stable over a six-month follow-up. Conclusions: This case underscores the complexity of managing patients with systemic atherosclerosis and highlights the need for individualized treatment strategies. While renal artery angioplasty may offer benefits in selected patients, its role should be carefully considered within the broader context of comprehensive cardiovascular risk management.