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Figure 7 Renal Artery Angioplasty for Fibromuscular Dysplasia and Hypertension
A 39-year-old woman presented with poorly controlled hypertension despite being treated with 2 antihypertensive medications. A renal artery magnetic resonance angiogram suggested right renal artery stenosis. (A) Selective right renal artery angiography demonstrating the classic "beaded" appearance of fibromuscular dysplasia. (B) Selective right renal artery angiography after percutaneous transluminal balloon angioplasty (PTA) continues to demonstrate the classic "beaded" appearance of FMD with a minor angiographic change (arrow) just before the renal artery bifurcation. (C) Results of PressureWire measurement depicting the phasic and mean proximal renal artery pressure (Pa), phasic and mean distal renal artery pressure (Pd), and fractional flow reserve (FFR). This figure demonstrates a distal renal artery to proximal renal artery peak-to-peak systolic gradient of 42 mm Hg, mean pressure gradient of 30 mm Hg, and a mean distal to proximal artery pressure ratio of 0.71. (D) After successful PTA, PressureWire measurement reveals a 0 mm Hg residual gradient and a mean distal to proximal renal artery pressure ratio of 1.0. The patient’s hypertension resolved at follow-up examination, and she did not require any antihypertensive therapy. Adapted with permission from Mahmud et al. (79).
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