Preventive stent placement for renal artery stenosis prior to emergent coronary artery bypass grafting.

PURPOSE: To illustrate the benefits of treating severe renal artery stenosis in renally compromised patients prior to surgery for coronary artery disease. CASE REPORT: A 63-year-old woman with unstable angina, severe coronary artery disease, and long-term severe renal impairment with a single functioning kidney underwent renal stent placement for high-grade renal artery stenosis prior to coronary artery surgery. The procedure improved her serum creatinine from 528 micromol/L at baseline to 385 micromol/L, and she subsequently underwent coronary artery bypass grafting without deterioration in her renal function. At 1 year, the patient has a serum creatinine of 400 micromol/L, and there is no evidence of in-stent stenosis.
CONCLUSIONS: Percutaneous renal angioplasty or stenting prior to coronary surgery in patients with concomitant renal and coronary artery disease may reduce perioperative renal deterioration in this specific group of patients.