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 !