LAUSR

Objectives: Percutaneous transluminal renal angioplasty (PTRA) without stenting is the recommended treatment for hypertensive children with renal artery stenosis (RAS). Not infrequently RAS is resistant to PTRA or recurs after the procedure. To circumvent PTRA limitations percutaneous cutting balloon angioplasty (PCBA) has been used occasionally but caution is warranted because of the risk of rupture or dissection of renal artery. The technical improvements in PCBA prompted us to exploit this procedure in children with severe hypertension and RAS resistant to PTRA Methods: eleven children (9.3–15.5years)with resistant RAS underwent PCBA. In 8 patients (pts)RAS was due to fibromuscular dysplasia (2bilateral)and in the remaining 3 was due to aortic narrowing extending to renal arteries (1 bilateral). In 3pts in addition to PCBA stenting of the aorta (1pt) and of RAS (2pts) was also applied. Office blood pressure (BP),24 h ambulatory BP monitoring (ABPM) (4/11pts), renal function and ultrasound (US) of renal arteries were evaluated before and after PCBA after a mean follow up of 5 months Results: PCBA achieved dilation of RAS in all cases. No significant complications occurred. At follow-up no restenosis were found at US investigation. Hypertension was cured in 7pts and improved in the remaining 4pts. After PCBA mean office systolic and diastolic BP (SBP and DBP mmHg) were reduced respectively from 138 ± 19 to 120 ± 11 and from 86 ± 13. to 69 ± 11 (p < 0.05 for both). With ABPM, SBP and DBP decreased respectively from 145 ± 3 to 130 ± 3 and from 88 ± 14 to 79 ± 16 (p < 0.05 for both). The antihypertensive agents assumed by pts with improved BP decreased from a mean of 3 to 0.5 per day. No significant changes were found in renal function after PCBA Conclusion: in our experience PCBA appears a safe and effective treatment of RAS resistant to PTRA