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经桡肾动脉支架术 Transradial Approach in Renal Stenting

经桡肾动脉支架术 Transradial Approach in Renal Stenting. Jianfang Luo 罗建方 Guangdong General Hospital. Renovascular Disease Sites and Characteristics. Atherosclerotic Ostial in nature Usually extends into the aorta >90% of renal stenoses Often Bilateral in patients >50 years

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经桡肾动脉支架术 Transradial Approach in Renal Stenting

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  1. 经桡肾动脉支架术Transradial Approach in Renal Stenting Jianfang Luo 罗建方Guangdong General Hospital

  2. Renovascular Disease Sites and Characteristics • Atherosclerotic • Ostial in nature • Usually extends into the aorta • >90% of renal stenoses • Often Bilateral in patients >50 years • Fibromusclar dysplasia (FMD) • Series of arterial webs • More common in females Atherosclerotic Fibromusclar dysplasia

  3. Prevalence Prog Cardiovasc Dis 2009;52:184-195

  4. Clinical presentation • Hypertension • Renal dysfunction • Cardiac disorder syndromes

  5. Traditional intervention of renal artery stenosis • Transfemoral intervention (TFI) • Guiding catheter: 6/7/8F (RDC, JR) • Guidingwire: 0.014 /0.018” • Stent: 5,6,7/15-24mm

  6. Limitations of TFI

  7. Limitations of TFI

  8. Transradial intervention (TRI) may be an alternative approach

  9. Why TRI - renal artery stenting ? • Anatomy • Avoid difficulties of TFI • Most common course of renal artery points downward • Renal artery diameter : 4~7 mm allows for low profile devices A= 75°B= 85° • Device • 6F long guiding catheter / wire / balloon • 6F GD compatible stent systems

  10. A long Guiding Catheter

  11. 6F 125cm guiding catheter compatible stent systems Stent Shaft (L)GW 6F Guiding Stent (L) (cm) (inch) (mm) (mm) Palmaze Blue 142 0.014 5,6 12,15,18,24 Hippocampus 145 0.014 4~7 10,15,20,24 Express SD 150 0.018 4~6 15,18

  12. TRI via right radial artery TRI via left radial artery

  13. Indications • Steeply down-going renal arteries • Avoid manipulation within an infra-renal AAA • Patients without femoral access • Aortic or iliac occlusion • By the way on TRI-PCI

  14. Limitations • Distance: Radial to renal artery • May be prohibitive in tall patients（>175cm) • Subclavian tortuosity / Type Ⅲ aortic arch • Not prohibitive in most, but can make guiding manipulation challenging • Access issues • Failure to gain access higher with radial artery

  15. Type of aortic arch Ⅰ Ⅱ Ⅲ

  16. Stiffness of stent catheter shaft Hippocampus Express SD ˃ Palmaze Blue ˃

  17. Case 1 • M , 64Y , Complaints " Shortness of breath after repeated activity for 3 yrs " • Hypertension, DM • CREA of admission : 130 umol/l

  18. TFI - renal stenting 6F JR4.0 6F JR4 Pre-dilatation stent not cross lesion!

  19. TRI - renal stenting Stenting TRI - 6F 125cm MPA1

  20. TRI - renal stenting Final result

  21. Case 2 • M , 67Y , Complaints " Lower extremity pain after activity for 7 yrs " • Hypertension, DM • CREA in admission : 254 umol/l

  22. TRI - renal stenting TRI - 5F MPA TRI - 6F 125cm MPA1

  23. TRI - renal stenting Final result

  24. Conclusion • TRI has obvious advantages in patients with difficult TFI and caudally angulated renal arteries • TRI for renal stenting might represent a valuable approach to reduce complications and improve patient’s comfort comparing with TFI • Appropriate patients’and compatible devices’selection are needed when consider to apply TRI for renal stenting

  25. Thank you !

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