LAUSR

Objective: Renovascular Hypertension in children (RVH), can be related to Fibrodysplasia, Neurofibromatosis, Alagille's and William's syndrome or Takayasu's. It is generally severe and difficult to control by drug treatment. Surgical or interventional treatments, are reported to have a high rate of failure. The clinical approach to the correct treatment requires a multidisciplinary strategy and a life-long follow-up Design and method: Recently our multidisciplinary pediatric team has expanded with interventional cardiologists with extensive experience in the treatment of complex coronary lesions The application of the methods of treatment of coronary lesions and the employment of the specific devices used in these diseases has been a breakthrough in the treatment of complex renal stenoses. Results: 13/14 patients (9–12 years) affected by RVH underwent Percutaneous Interventional Procedures after a complete diagnostic and clinical evaluation A total of 20/22 lesions were treated percutaneously. A cutting balloon was employed in 19/20 lesions; a bare metal stent in 2; a bioresorbable scaffold stent (BVS) in 1, a meshed stent for a post-stenotic aneurysm in 1. There were 15 critical stenoses, 2 total occlusions of the renal artery, 2 bifurcational lesions, 1 post-stenotic aneurysms. The only patient treated surgically had a big aneurysm near the aorta wall. An elective radial approach with a 6 French catheter guide was possible in all but one case. FOLLOW-UP There were no serious procedural complications. In all cases there was a good clinical response with significant reduction of BP, drug treatment was discontinued in 9 and significantly reduced in 5 pts after a mean follow-up of 12 months (6y-3m). Follow-up of the lesions was performed by colordoppler and MRI: we have not seen recurrences so far. Conclusions: The identification of the correct therapeutic strategy with a multidisciplinary approach has proved to be fundamental in this series. The employment of the expertise and the devices used in the percutaneous treatment of complex coronary lesions in renal arterial stenosis of pediatric patients is the key to the treatment of lesions considered not amenable to correction or necessarily surgical candidates: in fact 13/14 patients were treated percutaneously.