Two Years Efficacy of Paclitaxel-Coated Balloon Dilation for In-Stent Renal Artery Restenosis Due to Takayasu Arteritis

Patient: Female, 19 Final Diagnosis: Renovascular hypertension Symptoms: Hypertension Medication: Anti-hypertensive agents Clinical Procedure: Percutaneous transluminal renal angioplasty Specialty: Cardiology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Endovascular procedures for renal artery stenosis induced by Takayasu arteritis include renal angioplasty (RA); sometimes renal artery bypass surgery may be required. Recently, there have been several reports about the use of drug-coated balloon (DCB) for renal artery stenosis in patients with Takayasu arteritis. CASE REPORT: A 19-year-old female was diagnosed with ulcerative colitis in 2012 and was on oral therapy. In 2015, she developed type V Takayasu arteritis, with 90% stenosis of the bilateral common carotid arteries, 90% stenosis of the right renal artery, and 75% stenosis of the infrarenal abdominal aorta. Her abdominal aortic stenosis reduced blood flow to the lower extremities and revascularization was required, so balloon dilatation of the abdominal aorta and renal angioplasty for right renal artery were performed at another hospital in March 2016. However, in-stent restenosis occurred 2 times, we performed renal angioplasty again with DCB. The patient has subsequently shown a stable course without recurrence of hypertension. At 2 years after renal angioplasty with the DCB, her serum renin and aldosterone levels were normal, there was no change of the right renal artery blood flow rate, and the blood pressure was normal. CONCLUSIONS: This case suggests that dilation of in-stent restenosis with a DCB is an effective strategy for renal artery stenosis in patients with Takayasu arteritis. It seems desirable to consider expanding the indications for use of DCB to include renal artery stenosis.