Vol 13, No 5 (2018)
Case report
Published online: 2018-09-19
Hugging balloon dilatation by noncompliant balloon to successfully dilate a stent refractory to routine peripheral transluminal renal angioplasty (PTRA)
Folia Cardiol 2018;13(5):456-460.
Abstract
A small portion of lesions are refractory even when very high pressures are used to deploy the stent. Here, we report a 7-years old boy referred for evaluation of refractory hypertension. There was a bruit on auscultation on the back in lumber region. Renal angiogram revealed bilateral renal artery stenosis. Right and left renal arteries were stented with 7x23 mm and 7x19 mm Hippocampus bare metal stent (Medtronic, USA). Despite delivering stent in left renal artery at 10 atm pressure, it didn’t open up properly. We successfully attempted the technique of hugging balloons or two noncompliant balloons- 4x10 mm each, inflated simultaneously side by side at 20 atm to successfully dilate the stent. This technique enables success as the geometry of two kissing balloons is different from one balloon. This altered geometric configuration may be important in successfully dilating a stent refractory to standard dilating techniques. Higher pressures can be attained with two smaller balloons as the burst pressure is higher in smaller balloons compared to larger balloons.
Keywords: burst pressurehugging balloon inflationkissing balloon inflationrefractory hypertensionrenal artery stenosis
References
- Khanna N, Pramesti R, Sinha S, et al. Juvenile Takayasu arteritis: a case report. J Indian Coll Cardiol. 2017; 7(1): 28–30.
- Kothari S. Takayasu's arteritis in children — a review. Images Paediatr Cardiol. 2001; 3(4): 4–23.
- Hahn D, Thomson PD, Kala U, et al. A review of Takayasu's arteritis in children in Gauteng, South Africa. Pediatr Nephrol. 1998; 12(8): 668–675.
- Tyagi S, Kaul UA, Satsangi DK, et al. Percutaneous transluminal angioplasty for renovascular hypertension in children: initial and long-term results. Pediatrics. 1997; 99(1): 44–49.
- A pocket guide to blood pressure measurement in children by National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents within U. S. Department of Health and Human Services. National Institutes of Health: National Lung, Heart, and Blood Institute Washington, USA, 2007.
- Ozen S, Ruperto N, Dillon MJ, et al. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006; 65(7): 936–941.
- White CJ. Catheter-based therapy for atherosclerotic renal artery stenosis. Circulation. 2006; 113(11): 1464–1473.
- Leertouwer TC, Gussenhoven EJ, Bosch JL, et al. Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology. 2000; 216(1): 78–85.
