Successful percutaneous transluminal renal angioplasty with multimodality imaging guidance for a juvenile patient with renovascular hypertension due to fibromuscular dysplasia.

Percutaneous transluminal renal angioplasty (PTRA) is an effective treatment for renovascular hypertension due to fibromuscular dysplasia (FMD). PTRA for renovascular FMD is performed with only balloons based on the consensus that stent kinking and fracture have been reported in cases of PTRA using stents for FMD. Therefore, it is important to avoid procedural complications, such as flow-limiting dissection or arterial rupture, in PTRA for renovascular FMD.We present a case of a juvenile patient who presented with renovascular hypertension due to FMD. Angiography revealed focal stenosis of the right renal artery, and the pressure wire showed a resting distal coronary to aortic pressure ratio (Pd/Pa) of 0.83. Intravascular ultrasound (IVUS) showed an intima-media complex that could not be qualitatively assessed. Optical coherence tomography (OCT) showed intimal fibroplasia and medial hyperplasia with areas of low intensity. Based on the OCT images, balloon angioplasty was performed using a semi-compliant balloon. After balloon angioplasty, IVUS and OCT revealed luminal expansion with mild residual stenosis, and the Pd/Pa ratio was 0.99. We decided not to increase the balloon size to avoid vascular injuries. In conclusion, PTRA with only balloon can be safely performed for FMD under the guidance of multimodal imaging, using IVUS, OCT, and a pressure wire. Learning objectives: This report describes successful percutaneous transluminal renal angioplasty (PTRA) for a juvenile patient with renovascular hypertension due to fibromuscular dysplasia (FMD) under the guidance of multimodal imaging, using intravascular ultrasound (IVUS), optical coherence tomography (OCT), and a pressure wire. When IVUS for FMD cannot assess the culprit lesion qualitatively, OCT could be effective in performing angioplasty with only balloon, without significant vascular injuries. A pressure wire can show the endpoint of PTRA and help avoid increasing the balloon size to prevent significant vascular injuries.