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1、Endovascular Treatment of Renal Artery Stenosis,Clinical Indications(Procedures),Anatomy,Kidney anatomy,Endovascular Treatment of Renal Artery Stenoses,Aim of the treatment1)Renovascular Hypertension 2)Renal Insufficiency,Renovascular Hypertension,5%of all hypertensive patientsDue to atherosclerosis
2、 or FMDDiagnosed after Surgical follow-up or PTRA.PTRA does not cure Essential Hypertension,Renal Insufficiency,Nephrosclerosis after RAS or occlusionPTRA is indicated to reverse or prevent the decline of kidney functions8cm long kidney is the lower limit after which kidney function might be comprom
3、ised,Indications for PTRA,Failed medical therapyReducing drug treatmentPressure gradient 10%More than 50%stenosisAssymmetrical loss of renal mass,Endovascular Treatment of Renal Artery Stenoses,1)Treatment of artheriosclerotic ostial lesions(80%)dilatation+stenting2)Treatment of post ostial lesions
4、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).,Treatment Options,Medical T
5、reatmentPTA with StentingSurgeryDialysis:Renal Function never get better,Gold standard treatment today,Medical treatmentACE inhibitors and a new class of Angiotensin receptor blockers,Endovascular Options:PTA or Stenting?,1999:Peter Van de Ven,randomized trialPTA vs Stenting in ostial lesion,Literat
6、ure,Product Strategies,014”Cardiologist,Radiologists,Vasc Surgeons.Balloon:M3 RxStents:Corinthian IQ on M3Wire,Stabilizer 7-8F Vista Brite Tip or IG,035 Radiologist who are used to traditional PTA balloons,More range in PTA balloonsBalloons:P3,Opta ProStents:Genesis premounted on OPTA-PROWire 035,Ji
7、ndo,Storq8F Vista brite Tip or IG,A new approach:.018!,A GOOD COMPROMISE!Radiologist who are used to traditional PTA balloons,More range in PTA balloonsBalloons:SlalomStent:Genesis premounted on OPTA-PROWire 018,SV6-7F Vista brite Tip or IG,Advantages of.014 systems,Less spasm with.014 wireLess wire
8、 lengthSmaller puncture siteStent protected by GCGood support,Endovascular Treatment of Renal Artery Stenoses,Through the groin using 8F materialsCan be downsized to 7F using M3,Emerald.035,Emerald.035+Pigtail Tempo 4-5F 65cm,Emerald.035+Renal Curve Tempo 4F 65cm,Emerald.035+Renal Curve Tempo 4F 65c
9、m,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.035+RDC VBT 8F 55cm+Corinthian IQ on Opta Pro,Emerald.035+RDC VBT 8F 55cm+Corinthian IQ on Opta Pro,Emerald.035
10、+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 Renal Artery Stenoses,2)Through the groin using the new 6F materials,.014 Stabilizer,.014 Stabilizer+6F Brite Tip Sheath 55cm,.014 Stab
11、ilizer+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 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+Corinth
12、ian IQ,Endovascular Treatment of Renal Artery Stenoses,3)Through a brachial access,Tempo 4F MP+.014 Stabilizer,Brite Tip Sheath 6F 90cm+.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 Stabiliz
13、er+M3,BTS 6F 90cm+.014 Stabilizer+M3,BTS 6F 90cm+.014 Stabilizer+Corinthian IQ on M3,BTS 6F 90cm+.014 Stabilizer+Corinthian IQ on M3,BTS 6F 90cm+.014 Stabilizer+Corinthian IQ on M3,Endovascular Treatment of Renal Artery Stenoses,Procedural,Post procedure,Endovascular Treatment of Renal Artery Stenoses,Pre operative,Post operative,
