Successful cutting balloon angioplasty in a child with resistant renal artery stenosis

Jae Sung Son

Although renovascular hypertension is a rare disease, it is associated with 5-10 % of cases of childhood hypertension. It is a potentially treatable cause of hypertension, and is often caused by renal artery stenosis (RAS). The most common cause of RAS in children is fibromuscular dysplasia (FMD). The options for treating RAS depend on the location, severity and abnormality underlying the condition. A previously healthy 7-year-old Korean boy presented to our clinic with hypertension and headache. Renal ultrasonography and multi-detector computed tomography (MDCT) showed severe focal stenosis at the middle portion of the left renal artery (LRA) and multiple collateral vessels. Percutaneous balloon angioplasty was performed as an initial treatment, but yielded unsatisfactory results. The presence of intimal-type FMD was suspected based on his clinical features, angiographic appearance, and resistance to percutaneous transluminal renal angioplasty. Thereafter, his blood pressure was normalized using antihypertensive medication. Follow-up multi-detector computed tomography at 11 years of age showed persistent severe stenosis of the LRA. After unsuccessful attempts to perform balloon angioplasty, 3.5-mm cutting balloon angioplasty (CBA) was performed and yielded satisfactory results. He was discharged without any medication. At 1 year and 6 months after the intervention, he has been normotensive and had not required any antihypertensive medication. The author describes a case of resistant RAS that was detected on MDCT and successfully treated using percutaneous (CBA). Although cutting balloon angioplasty is useful in many clinical conditions, including the current case, clinicians should carefully consider the associated risk of arterial disruption and pseudoaneurysm formation.