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Figure 8 Renal Artery Stenting for Renovascular Hypertension

A 69-year-old man with a serum creatinine of 1.7 mg/dl and hypertension (blood pressure 158/97 mm Hg) despite treatment with 4 antihypertensive medications underwent magnetic resonance angiogram, which revealed a left renal artery stenosis. (A) On selective left renal artery angiography, a high-grade left renal artery stenosis of 90% (arrow) in the presence of an accessory left renal artery. (B) After balloon angioplasty, there is evidence of elastic recoil at the ostium and a residual stenosis (arrow) without complete resolution of the pressure gradient across the stenosis. (C) After placement of a 6.0 x 18 mm Herculink stent (Guidant, Temecula, California) in the main renal artery (arrow) and a 3.5 x 13 mm Cypher drug-eluting stent (Cordis, Miami, Florida) in the accessory renal artery, no residual stenosis remains. At 6-month follow-up, the patient had a blood pressure of 130/85 mm Hg and required treatment with 2 antihypertensive medications.