Bhagat K. Reddy, MD, FACC -

Bhagat K. Reddy, MD, FACC -

Renal IVUS

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

Director of Vascular Medicine & Endovascular Interventions

Piedmont Hospital

Atlanta, GA, USA



• Detect hemodynamically significant disease

• Decrease contrast load

• Decrease radiation

• Improve procedural outcomes



• 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


• 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



Posterior origin

LAO 60°

IVUS demarkating True Ostium of Renal artery




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


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



Final Angiogram

Inferior renal angiogram

demonstrating no crush of old stent

Renal IVUS



• Diagnostic

• Therapeutic

• Improve outcomes

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