Last updated: December 14, 2025
Besides primary hyperaldosteronism, renal artery stenosis is one of the main causes of secondary hypertension. In the vast majority of cases, atherosclerosis is the underlying cause of the stenosis, but fibromuscular dysplasia (FMD) is also a significant factor. Additionally, there are a few rarer forms of renal artery stenosis.
- Renal artery aneurysm
- Dissection of the renal artery and/or aorta
- Vasculitis (especially Takayasu arteritis)
- Neurofibromatosis type 1
- Pheochromocytoma
- Trauma
- Retroperitoneal fibrosis
- Radiation damage
- Post-transplantation stenosis
- Injury from renal denervation
- External compression (tumor, fibrous band)
- Persistent spasms due to medications (ergotamine, cocaine)
Presentation
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Anatomy
Indications
Certain Indications
* Acute ('flash') pulmonary edema
* Rapid decline in kidney function and global renal ischemia due to bilateral renal artery stenosis or unilateral stenosis in a solitary kidney
Possible Indications
* Unstable angina pectoris despite maximum medical therapy
* Recurrent episodes of heart failure despite optimal medical treatment
* Resistant hypertension
* Rapid decline in kidney function associated with unilateral renal artery stenosis
Contra Indications
Workup
- Hydration
Material
Essentials
- Chlorhexidine
- Standard angiography set
- Lidocaine 1% 10 ml
- Contrast
- Heparine 5.000 IE/ml
- 6F Introducer
- 0.035" Terumo Stiff guidewire
- 0.018" Wire
- 3 mm POBA
- Balloon Expandable stent (5-6 mm)
- Closure Device
Non Essentials
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Positioning
- Head first
- Supine
Steps
- Time out
- Positioning the patient
- Prepare with desinfectans and sterile cloth
- Access the artery retrograde ultrasound guided
- Administer 5000 IE Heparin
No Touch Technique
* 0.035-inch, J-tip guidewire is advanced into the abdominal aorta superior to the renal arteries
* Over this wire, the guide catheter is advanced in proximity to the renal artery
* 0.035-inch wire is then retracted to the soft portion of the wire so that the guiding catheter begins to assume the ostium of the renal artery
* The J-shaped portion of the wire is left outside the aorta wall
* Guiding catheter is gently rotated and advanced further into the renal artery
* A 0.018-inch wire is then inserted through the guiding catheter into the renal artery. The 0.035-inch J wire is removed
* Guiding is advanced over the 0.018-inch wire
* Position the chosen stent, protruding 1-2 mm in the aorta
* Place the stent
* Support the stent with the guiding catheter while retracting the balloon
* Do not remove the wire yet
* Post balloon angioplasty angiogram from a little distance of the origin of the renal artery
* Then remove the wire
* Sign out
Tips & Tricks
- For ostial lesions, it is important to deploy the stent with the proximal segment protruding 1–2 mm inside the aorta
- Size according to the normal renal caliber and not the adjacent post stenotic dilatation
- Higher-pressure inflations should be avoided in case of flank pain
- Avoid over dilation as aorta or renal artery dissection is a dreaded consequence
- Use of DES in the initial treatment does not be recommended at this time
- For in-stent restenosis, DES can be considered depending on the size of the renal artery
- Groin hematomas, retroperitoneal hemorrhage, pseudoaneurysm, arteriovenous fistula, and infection
- Atheroembolism into the renal or peripheral vascular bed: cholesterol embolization
- Dissection of renal artery or the wall of the aorta
- Acute or delayed thrombosis
- Rupture of renal artery
- Renal perforation
- Ascal 80 mg daily for 3 months
- Clopidogrel 75 mg daily