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Chapter 52. Renal Artery Angioplasty and Stenting

A 52-year-old woman undergoes magnetic resonance angiography (MRA) of the abdomen for abdominal pain, which identifies a unilateral 80% left renal artery stenosis. She is referred to you for an opinion regarding treatment. The patient has normal renal function and a diagnosis of hypertension, which is well controlled on 2 medications. Which of the following is appropriate?

A. Perform a renal ultrasound to obtain a baseline image and velocity.

B. Perform an angiogram to confirm the MRA stenosis.

C. Perform an angiogram with renal stenting.

D. There is no need for renal stenting unless her blood pressure becomes uncontrolled.

The correct answer is D

There is no indication for revascularization of asymptomatic renal artery stenosis.

A 72-year-old man with a known unilateral 70% renal artery stenosis and normal renal function is referred for further evaluation by his primary care physician. His blood pressure has ranged from 150/92 mm Hg to 165/88 mm Hg on his home blood pressure cuff over the past several weeks. He is taking a diuretic and an angiotensin-converting enzyme (ACE) inhibitor for his hypertension. In the office today, you measure his blood pressure at 138/86 mm Hg in both arms after 5 minutes of resting. Which of the following is appropriate?

A. Add a β-blocker to his regimen.

B. Add a calcium antagonist to his regimen.

C. Repeat the ultrasound to look for progression of the lesion.

D. Ask him to bring his home cuff into the clinic so that it can be checked against the clinic blood pressure cuffs.

The correct answer is D

There is no indication for intervention. It is important to resolve any systematic measurement differences on home equipment.

An 82-year-old woman presents to the emergency department in acute heart failure manifested by pulmonary edema. She is managed with diuretics. Her blood pressure is 142/90 mm Hg on diuretics and a β-blocker. During her hospital stay, an abdominal ultrasound reveals a 60% to 99% unilateral right renal artery stenosis. Her renal function is mildly impaired with an estimated creatinine clearance of 62 mL/min. Which of the following is most appropriate?

A. Perform an angiogram, and if an ischemic renal artery stenosis is confirmed, perform renal stenting.

B. Add an ACE inhibitor.

C. Add ...

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