Transradial approach for renal artery stenting

Percutaneous interventional procedures in the renal arteries are usually pe rformed using a femoral or brachial vascular access. The transradial approa ch, which has been extensively investigated for coronary angiography and in tervention, could be an attractive new technique for renal artery angioplas ty and stenting. In 18 patients with hemodynamically relevant unilateral re nal artery stenosis (mean diameter stenosis, 83% +/- 18%; right, n = 7; lef t, n = 11), interventional treatment with PTA and stenting was performed us ing a left (n = 16) or right (n = 2) radial artery access. Indications for the transradial approach were acute aorto-renal angles or severe peripheral arterial obstructions. After engagement of the renal artery ostium with a 6 Fr Multipurpose guiding catheter (length, 125 cm; Cordis) the stenosis wa s passed with a 0.014" guidewire followed by stent implantation (ACS Multi- Link RX Ultra, Guidant; length, 18 mm; diameter, 5 mm). Direct stenting was successfully performed in 16 cases. Predilatations were required in two ca ses. In five patients, optimal stent expansion was achieved by additional p ostdilatations. A primary technical success (residual stenosis < 30%) could be achieved in all cases. There were no periprocedural complications. Acco rding to color-coded doppler ultrasound, all access site arteries showed a normal perfusion. Clinically blood pressure control was improved in 11 pati ents with a significant reduction in systolic and diastolic blood pressure values. Serum creatinine values dropped from 1.81 +/- 0.3 mg/di to 1.49 +/- 0.3 mg/dl (P < 0.001). Transradial renal artery angioplasty and stenting i s technically feasible and safe. Particularly in patients with unfavorable vessel anatomy, this new cranio-caudal approach is an attractive alternativ e technique. (C) 2001 Wiley-Liss, Inc.