RENAL-ARTERY STENOSIS PRESENTING AS CRESCENDO ANGINA-PECTORIS

The coexistence of different clinical syndromes due to atherosclerosis in different organs is not rare and emphasizes the diffuse nature of this vascular process. Although renovascular disease may cause hyperte nsion and/or renal insufficiency, it may also occur in the absence of the usual clinical markers that suggest renovascular hypertension. We report a patient with stable coronary anatomy who presented with cresc endo angina pectoris. Diagnosis of renovascular hypertension was made by screening renal angiography at the time of the cardiac catheterizat ion. Renal artery stenting resulted in stabilization of the coronary s yndrome and obviated the need for further coronary intervention. To ou r knowledge, this is the first case of renovascular hypertension preci pitating an unstable coronary syndrome in a patient with documented st able coronary anatomy. Review of the literature supports that patients undergoing cardiac catheterization are a high risk population for ren ovascular disease, particularly in the presence of other predictive fa ctors such as documented coronary artery disease, older age, female ge nder, congestive heart failure, peripheral vascular disease, renal ins ufficiency, and smoking. Firm recommendations for routine screening re nal angiography in patients undergoing peripheral or coronary angiogra phy will need further studies. (C) 1995 Wiley-Liss, Inc.