PMC8254557_01
Various Imaging modalities used in diagnosing Renal artery stenosis in fibromuscular dysplasia.
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Contrast-enhanced Computed Tomography (CT) (Figure 1A) and conventional angiography (Figure 1B and C) showed critical focal stenosis in the mid-segment of the bilateral main renal arteries, which in a young female, although suggestive but is not diagnostic of FMD. OCT imaging of the left renal artery revealed a characteristic string of beads appearance in longitudinal reconstruction (Figure 1D). Cross-sectional images show an intima-media dissection (Figure 1E) and homogeneously thickened media as a low backscatter layer with a high backscatter in the inner half suggestive of fibrosis. OCT quantified luminal area stenosis to 92% (Figure 1F) with a normal reference segment (Figure 1G). OCT of the right renal artery (done after balloon) angioplasty revealed a homogeneously thickened media with minimal fibrosis suggestive of medial fibroplasia (Figure 1H).
Current bilateral renal angiogram showing significant restenosis (arrows) in the left (A) and right (B) renal arteries. Longitudinal reconstruction of optical coherence tomography (OCT) imaging (C) of left renal artery depicting the corresponding lesion indicated by white arrows. Cross-sectional images showing distal (D) and proximal (F) reference zones are free of disease and measure 4.2mm. The area of focal restenosis on the angiogram correlate with extensive medial and intimal hyperplasia (arrows) on OCT (E), causing 87% area (re) stenosis.
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A repeat renal Doppler was suggestive of bilateral renal artery stenosis, and a renal artery angiography revealed 90% bilateral focal restenosis at the previous sites (Figure 2A and B). OCT of the left renal artery revealed focal stenosis with homogeneously thickened media with fibrosis in the inner half, as on the initial imaging (Figure 2C-F).
Angiogram showing stent deployment in the left renal artery (A) with an excellent angiographic result (B). The right renal artery shows (C) a good result with balloon angioplasty alone. Longitudinal (D) and cross-sectional (E) OCT images of left renal artery show good stent expansion and apposition (arrows) without residual stenosis. Cross-sectional OCT image (F) of right renal artery after balloon angioplasty shows good result with some intimal tears (arrows) and no residual stenosis (correlate with Image (C)).
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OCT imaging confirmed good stent expansion and apposition (Figure 3A-E). On the right side, there was no pressure gradient after balloon angioplasty with a 4.5 mm balloon, so stenting was not performed (Figure 3C and F).