Bhagat K. Reddy, MD, FACC - summitMD.com

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Bhagat K. Reddy, MD, FACC - summitMD.com

Renal IVUS

Bhagat K. Reddy, M.D., F.A.C.C

Director of Vascular Medicine & Endovascular Interventions

Piedmont Hospital

Atlanta, GA, USA


Advantages

Diagnostic

• Detect hemodynamically significant disease

• Decrease contrast load

• Decrease radiation

• Improve procedural outcomes


Advantages

Interventions

• Demarkate true ostia

• Coverage of lesion (esp. aorto-ostium)

• Stent apposition

• Stent expansion

• Facilitate intervention in complex anatomy

• In-stent restenosis evaluation


In-stent restenosis

Etiology

• Non coverage of true ostium

• Neointimal hyperplasia

• Incomplete stent expansion

• Stent mal-apposition


IVUS guided Renal stenting

• Incomplete stent expansion = 14.4%

• Dissection = 5.2%

• Uncovered ostia = 3.9%

(Additional stenting = 4.5%)

“Need for additional intervention = 23.5%”

n = 131, lesions = 153

• No IVUS related complications

• IVUS complements angiography in renal stenting

Dangas G, Laird JR et al J Endovasc Ther 2001;8:238-47


Leesar MA et al Am J Cardiol 2007;100:86


Leesar MA et al Am J Cardiol 2007;100:86


Leesar MA et al Am J Cardiol 2007;100:86


Ostial Lesion

? significance


Proximal Lesion

? significance


AP

AP

Posterior origin

LAO 60°


IVUS demarkating True Ostium of Renal artery

Ostium

Abdominal

aorta


In-stent restenosis


Cutting PTA Post PTA


In-stent restenosis


Unexpanded Stent


Unexpanded stent


Abdominal aortography not

adequate in detecting ostial RAS


Uncovered ostium

detected post stent

Watty missing ostial stenting


Lesion vs Bend


Post Stenting

no change at the Bend

Perez stent no change in the bend


Inferior branch

supplying superior 1/2

Separate ostia

vs

Early branching

Superior branch

supplying inferior 1/2


IVUS confirms

separate ostia

absence of wire passage through struts

of old stent in the inferior branch


70 deg LAO demonstrating

separate ostia of renal arteries


IVUS

Stenting


Final Angiogram

Inferior renal angiogram

demonstrating no crush of old stent


Renal IVUS

Conclusion

•Safe

• Diagnostic

• Therapeutic

• Improve outcomes

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