Limitations of Angiography for the Assessment of Renal Artery Stenosis and Treatment Implications

Renovascular hypertension due to atherosclerotic renal artery stenosis is the most common cause of secondary hypertension. Percutaneous catheter-based renal artery revascularization has been increasingly utilized for the treatment of renal artery stenosis. Renal artery stenting has a high technical success rate, but the rate of improvement in hypertension is somewhat less than expected with this technique. Misinterpretation of angiographic images may play a role in these unfavorable clinical results. We present a case in which the diagnosis of severe renal artery stenosis was not apparent by angiography. Intravascular ultrasound and translesional pressure gradient measurements during arteriography can help to determine the precise severity of stenosis and may augment the clinical results of percutaneous renal artery stent placement. (C) 2009 Wiley-Liss, Inc.