1、Endovascular Treatment of Renal Artery Stenosis,Clinical Indications (Procedures),Anatomy,Kidney anatomy,Endovascular Treatment of Renal Artery Stenoses,Aim of the treatment 1) Renovascular Hypertension 2) Renal Insufficiency,Renovascular Hypertension,5% of all hypertensive patients Due to atheroscl

2、erosis or FMD Diagnosed after Surgical follow-up or PTRA. PTRA does not cure Essential Hypertension,Renal Insufficiency,Nephrosclerosis after RAS or occlusion PTRA is indicated to reverse or prevent the decline of kidney functions 8cm long kidney is the lower limit after which kidney function might

3、be compromised,Indications for PTRA,Failed medical therapy Reducing drug treatment Pressure gradient 10% More than 50% stenosis Assymmetrical loss of renal mass,Endovascular Treatment of Renal Artery Stenoses,1) Treatment of artheriosclerotic ostial lesions (80%) dilatation + stenting 2) Treatment o

4、f post ostial lesions dilatation (stenting if necessary) 3) Treatment FMD dilatation (stenting if necessary),Post-ostial lesion,Fibro-Muscular Dysplasia,Fibro-Muscular Dysplasia,Restenosis after stenting,Recent studies have indicated rates are between 10-20% (much better than the 30% with just PTA).

5、,Treatment Options,Medical Treatment PTA with Stenting Surgery Dialysis: Renal Function never get better,Gold standard treatment today,Medical treatment ACE inhibitors and a new class of Angiotensin receptor blockers,Endovascular Options: PTA or Stenting ?,1999: Peter Van de Ven, randomized trial PT

6、A vs Stenting in ostial lesion,Literature,Product Strategies,014” Cardiologist, Radiologists, Vasc Surgeons. Balloon: M3 Rx Stents: Corinthian IQ on M3 Wire, Stabilizer 7-8F Vista Brite Tip or IG,035 Radiologist who are used to traditional PTA balloons, More range in PTA balloons Balloons: P3, Opta

7、Pro Stents: Genesis premounted on OPTA -PRO Wire 035, Jindo, Storq 8F Vista brite Tip or IG,A new approach: .018 !,A GOOD COMPROMISE ! Radiologist who are used to traditional PTA balloons, More range in PTA balloons Balloons: Slalom Stent: Genesis premounted on OPTA -PRO Wire 018, SV 6-7F Vista brit

8、e Tip or IG,Advantages of .014 systems,Less spasm with .014 wire Less wire length Smaller puncture site Stent protected by GC Good support,Endovascular Treatment of Renal Artery Stenoses,Through the groin using 8F materials Can be downsized to 7F using M3,Emerald .035,Emerald .035 + Pigtail Tempo 4-

9、5F 65cm,Emerald .035 + Renal Curve Tempo 4F 65cm,Emerald .035 + Renal Curve Tempo 4F 65cm,Emerald .035 + RDC Vista Brite Tip 8F 55cm,Emerald .035 + RDC VBT 8F 55cm + Opta Pro,Emerald .035 + RDC VBT 8F 55cm + Opta Pro,Emerald .035 + RDC VBT 8F 55cm + Opta Pro,Emerald .035 + RDC VBT 8F 55cm,Emerald .0

10、35 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro,Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro,Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro,Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ on Opta Pro,Emerald .035 + RDC VBT 8F 55cm + Corinthian IQ,Endovascular Treatment of R

11、enal Artery Stenoses,2) Through the groin using the new 6F materials,.014 Stabilizer,.014 Stabilizer + 6F Brite Tip Sheath 55cm,.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F,.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F,.014 Stabilizer + 6F BTS 55cm +RDC Tempo 4F,.014 Stabilizer + 6F BTS 55cm +RDC Tempo

12、 4F,.014 Stabilizer + 6F BTS 55cm + M3,.014 Stabilizer + 6F BTS 55cm + M3,.014 Stabilizer + 6F BTS 55cm + Corinthian IQ on M3,.014 Stabilizer + 6F BTS 55cm + Corinthian IQ,Endovascular Treatment of Renal Artery Stenoses,3) Through a brachial access,Tempo 4F MP + .014 Stabilizer,Brite Tip Sheath 6F 9

13、0cm + .014 Stabilizer,Brite Tip Sheath 6F 90cm + .014 Stabilizer,Brite Tip Sheath 6F 90cm + RDC Tempo 4F +.014 Stabilizer,BTS 6F 90cm +.014 Stabilizer,BTS 6F 90cm +.014 Stabilizer + M3,BTS 6F 90cm +.014 Stabilizer + M3,BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on M3,BTS 6F 90cm +.014 Stabilizer + Corinthian IQ on