A 54-year-old man with a diffuse type of atherosclerosis, including coronary three-vessel disease with severely impaired left ventricular function after posterior wall infarction, high-grade stenosis of the left subclavian artery, occlusion of the left common and superficial femoral arteries, occlusion of the right superficial femoral artery, and 90% stenosis of the left renal artery, was referred for interventional and surgical therapy. Known risk factors were smoking, hyperlipidemia, and hypertension. The serum creatinine concentration was elevated by 1.35 mg/dL, and the creatinine clearance was reduced by 58 mL/min. Average blood pressure measurements obtained by ambulatory 24-hour monitoring were systolic, 146 mm Hg; diastolic, 83 mm Hg; and mean, 102 mm Hg. The patient was taking three antihypertensive drugs. The difference of the intrarenal resistance index between the two kidneys, according to Pourcelot, was 0.09 (0.68 for the right kidney and 0.59 for the left kidney).
Stent-supported angioplasty of the left subclavian artery and left renal artery (implantation of a Palmaz P 204 stent, 5-mm balloon) and recanalization of the left common and superficial femoral arteries were performed in the first session. Recanalization of the right superficial femoral artery was performed in the second session. Six weeks later, the patient successfully underwent surgical coronary artery revascularization.
The resistance index of the left kidney was equalized immediately after the intervention (0.68 for both kidneys). After 6 and 12 months, serum creatinine concentration decreased to 1.00 mg/dL and 0.95 mg/dL, respectively, and creatinine clearance increased to 83 mL/min and 88 mL/min, respectively. Average blood pressure measurements dropped to 127/71 mm Hg with a mean of 92 mm Hg at 6 months and 121/75 mm Hg with a mean of 91 mm Hg at 12 months, despite an ongoing reduction of antihypertensive drugs by one drug.
This patient, who had a diffuse type of atherosclerosis, underlines
the results of our study, showing that patients benefit from stent-supported revascularization, even with unilateral severe renal artery stenosis, par-
ticularly those with preinterventionally impaired renal and left ventricular function.