Stant restenosis in a patient with vazorenal arterial hypertension
Introduction. Up to 20% so-called secondary forms of hypertension are associated with vascular pathology of the kidneys (renovascular hypertension). The lack of effectiveness of drug therapy of this form of hypertension determined the invasive treatment tactics.
Objectives. The purpose of this article was to observe the clinical course of renovascular hypertension and determine the tactics of treatment in the long-term period after a previous stenting of the renal arteries.
Material and methods. Our patient is a woman, born in 1957. Since 2011, hypertension has been diagnosed, since 2014 - rhythm disturbances, since 2015 edema of the lower extremities, maximum blood pressure up to 250/120 mm Hg, in 2016 - stenting of the renal arteries (RA) was performed according to the angiography results, the patient's condition was satisfactory. Since 2018, due to deterioration, the patient was hospitalized. The main diagnosis: Secondary vasorenal arterial hypertension of the II stage, 3 degree. Bilateral renal artery stenosis (angiography 03.03.2016). Renal artery stenting (03.03.2016). Restenosis of the stent of the right renal artery up to 80% (angiography 15.11.2018). Ventricular extrasystole II gradation according to Laun-Wolf-Rayan. Hyperlipidemia type IIb-III. Very high cardiovascular risk. Complication: Hypertensive crisis (uncomplicated course) (01.1I.2018). HF II A stage, class II with preserved systolic function of the left ventricle (EF 69%). Conducted therapy: perindopril 15 mg, bisoprolol 5 mg, torasemide 5 mg; amiodarone 100 mg bid; indapamide 1.25 mg; amlodipine 5 mg, acetylsalicylic acid 150 mg; rosuvastatin 20 mg.
Results. The patient underwent a standard examination at hospital. Identified deviations: laboratory: ESR 20 mm / h, basophils 1.3%, creatinine 83 μmol / L (CKD-EPI 77 ml / min / 1.73 m2), dyslipidemia IIb according to Fredrickson; instrumental: ECG – left axis deviation, signs of left ventricular myocardial hypertrophy (LVMH); Holter - single ventricular and supraventricular extrasystoles; echocardiography - sclerotic changes in the valvular apparatus of the heart, concentric LVMH; ultrasound of the abdominal cavity and retroperitoneal space – the right kidney is reduced in size, microcalculosis of both kidneys, signs of stenotic flow along the left RA at the level of the stent; RA angiography - restenosis in the stent of the right RA up to 80%. Stentoplasty with possible stent-to-stent DES stenting was recommended by an endovascular surgeon.
Conclusions. This clinical case demonstrates the need for screening a category of patients with resistance to standard antihypertensive therapy for the presence of secondary arterial hypertension, which will improve the quality of life of the patient and reduce the number of drugs used, in some cases up to their withdrawal. Given the high likelihood of restenosis of stented vessels, it is necessary to carry out primary prevention of the restenosis occurrence.
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