A 68-year-old female patient with a 5-year history of arterial hypertension and angiographically demonstrated coronary artery disease.
Clinically, the patient was asymptomatic and in functional capacity I. However, she always had very high blood pressure, with an average of 190/95 mmHg despite multiple drug regimens.
She was also allergic to hydrochlorothiazide and had elevated creatinine in relation to enalapril.
At the time of treatment with her arterial pressures, the following were observed: retard 20 mg x 2; tenolol 50 mg/day; minoxidil 5 mg/day; isoorbide mononitrate 190/60 mg x 2; atorvastatin 10 mg/day.
Due to the refractoriness and severity of the blood pressure figures, a study was carried out to look for a corregible cause and the renal angioresonance that later confirmed a renal ostium right coronary artery stenosis (>50%), at 1 cm.
Since the patient was functionally monorene, with severe refractory hypertension and significant focal stenosis in the left renal artery, angioplasty with stent was proposed with the primary purpose of modifying the progression of the renal damage.
Because the patient had a baseline creatinine level of 1.6 mg/dL, CO2 was planned to be used as a contrast agent and thus reduce exposure to contrast media and the risk of acute renal failure.
Procedure.
Through a right femoral arterial access, a Cordis 6F guide catheter was advanced and the ostium of the left renal artery was cannulated selectively.
This process was guided by manual injections of CO2, which was obtained directly from a reservoir balloon.
Using digital subtraction angiography 20 ml of CO2 was injected and a basal image was obtained; then, on a guide of angioplasty of 0.014'''', an 18-mm stent without stenting was advanced over a balloon catheter.
The total volume of CO2 used was 160 ml.
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Since the first angioplasty with CO2 was performed, we performed an angioplasty with 24 ml of conventional contrast agent and isosmolar contrast medium to confirm the good result.
1.
One month after the procedure, the patient remained asymptomatic, with blood pressure (BP) 150/90 mmHg, maintaining her usual medications, except minoxidil, which was suspended one week after the procedure.
