经桡肾动脉支架术 transradial approach in renal stenting
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经桡肾动脉支架术经桡肾动脉支架术Transradial Approach in Renal Transradial Approach in Renal
Stenting Stenting
Jianfang Luo 罗建方Guangdong General Hospital
Renovascular Disease Renovascular Disease Sites and CharacteristicsSites and Characteristics
AtheroscleroticAtherosclerotic Ostial in natureOstial in nature Usually extends into the Usually extends into the
aortaaorta >90% of renal stenoses>90% of renal stenoses Often Bilateral in patients Often Bilateral in patients
>50 years>50 years
Fibromusclar dysplasia Fibromusclar dysplasia (FMD)(FMD)
Series of arterial websSeries of arterial webs More common in femalesMore common in females
Atherosclerotic
Fibromusclar dysplasiaFibromusclar dysplasia
PrevalencePrevalence
Prog Cardiovasc Dis 2009;52:184-195
Clinical presentationClinical presentation
Hypertension
Renal dysfunction
Cardiac disorder
syndromes
Traditional Traditional interventionintervention of of renal artery stenosisrenal artery stenosis
Transfemoral intervention (TFI)
Guiding catheter: 6/7/8F (RDC, JR)
Guiding wire: 0.014 /0.018”
Stent: 5,6,7/15-24mm
Limitations of TFI
Limitations of TFI
Transradial intervention (TRI) Transradial intervention (TRI)
may be an alternative approach
Why TRI - renal artery stenting ?Why TRI - renal artery stenting ?
AnatomyAnatomy Avoid difficulties of TFI Avoid difficulties of TFI Most common course of renal artery Most common course of renal artery
points downwardpoints downward Renal artery diameter : 4~7 mm Renal artery diameter : 4~7 mm
allows for low profile devicesallows for low profile devices
A= 75°B= 85°
Device 6F long guiding catheter / wire / balloon 6F GD compatible stent systems
A long Guiding CatheterA long Guiding Catheter
6F 125cm guiding catheter 6F 125cm guiding catheter compatible stent systemscompatible stent systems
Stent Shaft (L) GW 6F Guiding Stent (L)
(cm) (inch) (mm) (mm)
Palmaze Blue 142 0.014 5,6 12,15,18,24
Hippocampus 145 0.014 4~7 10,15,20,24
Express SD 150 0.018 4~6 15,18
TRI via right radial artery
TRI via left radial artery
Indications Indications
Steeply down-going renal arteriesSteeply down-going renal arteries
Avoid manipulation within an infra-renal AAAAvoid manipulation within an infra-renal AAA
Patients without femoral accessPatients without femoral access
Aortic or iliac occlusionAortic or iliac occlusion
By the way on TRI-PCIBy the way on TRI-PCI
LimitationsLimitations
Distance: Radial to renal arteryDistance: Radial to renal artery May be prohibitive in tall patientsMay be prohibitive in tall patients (( >175cm>175cm))
Subclavian tortuosity Subclavian tortuosity / Type / Type aortic arch Ⅲ aortic arch Ⅲ Not prohibitive in most, but can make guidNot prohibitive in most, but can make guidinging man man
ipulation challengingipulation challenging
Access issuesAccess issues Failure to gain access higher with Failure to gain access higher with rradial adial arteryartery
Type of aortic archType of aortic arch
ⅡⅠ Ⅲ
Stiffness of stent catheter shaftStiffness of stent catheter shaft
Hippocampus Express SD Palmaze Blue ˃˃
Case 1Case 1
M , 64Y , Complaints " Shortness of breath afM , 64Y , Complaints " Shortness of breath after repeated activity for 3 yrs "ter repeated activity for 3 yrs "
Hypertension, DHypertension, DMM
CREA of admission : 130 umol/lCREA of admission : 130 umol/l
6F JR4.0 6F JR4 Pre-dilatation stent not cross lesion!
TFI - renal stenting
StentingTRI - 6F 125cm MPA1
TRI - renal stenting
Final result
TRI - renal stenting
Case 2Case 2
M , 67Y , Complaints " Lower extremity pain M , 67Y , Complaints " Lower extremity pain after activity for 7 yrs "after activity for 7 yrs "
Hypertension, DHypertension, DMM
CREA CREA inin admission : 254 umol/l admission : 254 umol/l
TRI - 5F MPA TRI - 6F 125cm MPA1
TRI - renal stenting
Final result
TRI - renal stenting
ConclusionConclusion
TRITRI has obvious advantages in patients with difficult has obvious advantages in patients with difficult TFI TFI and caudally angulated renal arteries and caudally angulated renal arteries
TRI TRI for renal stenting might represent a valuable for renal stenting might represent a valuable approachapproach to reduce complications and improve patie to reduce complications and improve patientnt’’s comfort s comfort comparing with TFIcomparing with TFI
AAppropriate patientsppropriate patients’’ and and compatible devicescompatible devices’’ selection are needed when consider to apply TRI for selection are needed when consider to apply TRI for renal stentingrenal stenting
Thank Thank
you !you !
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