renal artery blockage

[q1108]

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if a renal artery is 70% blocked and the doc thinks this is the cause of high blood pressure what is usually done a stent put in?

 

[hans19]

if a renal artery is 70% blocked and the doc thinks this is the cause of high blood pressure what is usually done a stent put in?

Even with a renal artery partial blockage, likely the cause of htn is essential.
If its FMD or a concentric plaque you can do a trial of angioplasty, if its an eccentric lesion Stent. If its a cardiologist doing it $TENT first ask questions later. 😉

 

[Docxter]

Renal artery stenosis and renovascular hypertension are not synonymous. A 70% stenosis does not necessarily mean RAS is the cause of hypertension (renovascular hypertension), though it may be. Unfortunately, there isn't a 100% accurate test to prove causality here. You can use plasma renin activity, captopril-induced renal scintigraphy, etc, to help determine who may benefit from angioplasty-stenting (assuming it's atherosclerotic), but you have to be familiar with the limitations of these tests (e.g., high creatinine, bilateral stenosis, etc.). There has been a lot of research on selection of candidates who would benefit from PTAS, which you should take a look at. Unless you are part of an unfortunately not-so-small proportion of a particular specialty who practices the motto "stent who you can stent" rather than "stent who you should stent". It is sad, since a lot of this kind of research has been done by the cardiology community, but some cardiologists just seem to ignore them. Ever heard of "drive-by stenting"? If you haven't, it means putting a stent in the different branches coming off the aorta (renals, celiac, superior mesenteric, inferior mesenteric, iliac arteries) once your done stenting the coronaries. Whether the patients truly need these $tent$ or not, in the minds of some in this particular specialty, is a secondary and sometimes unimportant issue.

All that said, the particular circumstances of each patient is different, and you should consult your own doctor for patient-specific medical advice.

 

[LGMD]

Whats up with all this bashing cardiology?
Every stent question seems to end this way, sad but true...

 

[Docxter]

It's not bashing cardiology as a specialty. They are an indispensable and very important specialty, and leaders in many aspects of medical research. It's just the shady and dubious practices of some cardiologists, which unfortunately are not insignificant in number, though mostly out in private practice. Even some of my cardiologist colleagues at the university hospital are furious about the shady practices they see out there in the community.

 

[LGMD]

Hi Docxter, I completely get your point and you are right indeed. Sorry if I offended you.