open access

Vol 13, No 5 (2018)
Case Reports
Published online: 2018-09-19
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Hugging balloon dilatation by noncompliant balloon to successfully dilate a stent refractory to routine peripheral transluminal renal angioplasty (PTRA)

Santosh Kumar Sinha, Puneet Aggarwal, Lokendra Rekwal, Anupam Kumar Singh, Sunil Kumar Tripathi, Nishant Kumar Abhishekh
DOI: 10.5603/FC.a2018.0106
·
Folia Cardiologica 2018;13(5):456-460.

open access

Vol 13, No 5 (2018)
Case Reports
Published online: 2018-09-19

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.

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.
Get Citation

Keywords

burst pressure, hugging balloon inflation, kissing balloon inflation, refractory hypertension, renal artery stenosis

About this article
Title

Hugging balloon dilatation by noncompliant balloon to successfully dilate a stent refractory to routine peripheral transluminal renal angioplasty (PTRA)

Journal

Folia Cardiologica

Issue

Vol 13, No 5 (2018)

Pages

456-460

Published online

2018-09-19

DOI

10.5603/FC.a2018.0106

Bibliographic record

Folia Cardiologica 2018;13(5):456-460.

Keywords

burst pressure
hugging balloon inflation
kissing balloon inflation
refractory hypertension
renal artery stenosis

Authors

Santosh Kumar Sinha
Puneet Aggarwal
Lokendra Rekwal
Anupam Kumar Singh
Sunil Kumar Tripathi
Nishant Kumar Abhishekh

References (8)
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