Dilation of Renal Artery Stenosis after Administration of Losartan

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Abstract

Transluminal angioplasty with a balloon catheter is effective to dilate renal artery stenosis (RAS) caused by fibromuscular dysplasia (FMD), but lesions resistant to the angioplasty exist. In this report, we describe the case of a young woman with RAS of FMD that was difficult to dilate even by cutting-balloon angioplasty. To facilitate the formation of a smooth intimal covering at the site of angioplasty, we administered losartan, an angiotensin receptor blocker, for 4 months after the angioplasty. Although restenosis was detected at 5 months after the angioplasty, the normotensive state continued without antihypertensives and the restenosis gradually dilated afterwards. The present case suggests the possibility of remodeling the renal artery during the normotensive state by administering losartan after the angioplasty.

References

  1. 1

    Bokhari SW, Faxon DP : Current advances in the diagnosis and treatment of renal artery stenosis. Rev Cardiovasc Med 2004; 5: 204–215.

  2. 2

    Tegtmeyer CJ, Selby JB, Hartwell GD, Ayers C, Tegtmeyer V : Results and complications of angioplasty in fibromuscular disease. Circulation 1991; 83: I155–I161.

  3. 3

    White CJ, Ramee SR, Collins TJ, Jenkins JS, Escobar A, Shaw D : Renal artery stent placement: utility in lesions difficult to treat with balloon angioplasty. J Am Coll Cardiol 1997; 30: 1445–1450.

  4. 4

    Tanemoto M, Abe T, Chaki T, Satoh F, Ishibashi T, Ito S : Cutting balloon angioplasty of resistant renal artery stenosis caused by fibromuscular dysplasia. J Vasc Surg 2005; 41: 898–901.

  5. 5

    Perkovic V, Thomson KR, Mitchell PJ, et al: Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes. Australas Radiol 2001; 45: 438–443.

  6. 6

    Barath P, Fishbein MC, Vari S, Forrester JS : Cutting balloon: a novel approach to percutaneous angioplasty. Am J Cardiol 1991; 68: 1249–1252.

  7. 7

    Kyoraku Y, Kato J, Nishi Y, et al: Autotransplantation and stent implantation for bilateral renal artery fibromuscular dysplasia. Hypertens Res 1999; 22: 141–143.

  8. 8

    Stanley JS : Renal artery fibrodysplasia. in Novick AC ( ed): Renal Vascular Disease. London, WB Saunders Company Ltd, 1996, pp 21–33.

  9. 9

    Wilson DP, Saward L, Zahradka P, Cheung PK : Angiotensin II receptor antagonists prevent neointimal proliferation in a porcine coronary artery organ culture model. Cardiovasc Res 1999; 42: 761–772.

  10. 10

    Wilensky RL : Angiotensin-receptor blockers: revival of the systemic prevention of restenosis? Cardiovasc Drugs Ther 2003; 17: 63–73.

  11. 11

    Nemcek AA Sr, Holmburg CE : Reversible renal fibromuscular dysplasia. AJR Am J Roentgenol 1986; 147: 737–738.

  12. 12

    Osterrieder W, Muller RK, Powell JS, Clozel JP, Hefti F, Baumgartner HR : Role of angiotensin II in injury-induced neointima formation in rats. Hypertension 1991; 18: II60–II64.

  13. 13

    Kramer C, Sunkomat J, Witte J, et al: Angiotensin II receptor–independent antiinflammatory and antiaggregatory properties of losartan: role of the active metabolite EXP3179. Circ Res 2002; 90: 770–776.

  14. 14

    Fujikawa K, Hasebe N, Kikuchi K : Cost-effectiveness analysis of hypertension treatment: controlled release nifedipine and candesartan low-dose combination therapy in patients with essential hypertension—the Nifedipine and Candesartan Combination (NICE-Combi) Study. Hypertens Res 2005; 28: 585–591.

  15. 15

    Harrap SB, Van der Merwe WM, Griffin SA, Macpherson F, Lever AF : Brief angiotensin converting enzyme inhibitor treatment in young spontaneously hypertensive rats reduces blood pressure long-term. Hypertension 1990; 16: 603–614.

  16. 16

    Nakaya H, Sasamura H, Hayashi M, Saruta T : Temporary treatment of prepubescent rats with angiotensin inhibitors suppresses the development of hypertensive nephrosclerosis. J Am Soc Nephrol 2001; 12: 659–666.

  17. 17

    Habashi JP, Judge DP, Holm TM, et al: Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 2006; 312: 117–121.

  18. 18

    Hackam DG, Thiruchelvam D, Redelmeier DA : Angiotensin-converting enzyme inhibitors and aortic rupture: a population-based case-control study. Lancet 2006; 368: 659–665.

  19. 19

    Hara K, Kobayashi N, Nakano S, Mori Y, Tsubokou Y, Matsuoka H : Effects of TCV-116 on endothelin-1 and PDGF A–chain expression in angiotensin II–induced hypertensive rats. Hypertens Res 2001; 24: 55–64.

  20. 20

    Rakugi H, Wang DS, Dzau VJ, Pratt RE : Potential importance of tissue angiotensin-converting enzyme inhibition in preventing neointima formation. Circulation 1994; 90: 449–455.

  21. 21

    Navar LG, Harrison-Bernard LM : Intrarenal angiotensin II augmentation in angiotensin II dependent hypertension. Hypertens Res 2000; 23: 291–301.

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Correspondence to Masayuki Tanemoto.

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Tanemoto, M., Takase, K., Yamada, T. et al. Dilation of Renal Artery Stenosis after Administration of Losartan. Hypertens Res 30, 999–1002 (2007) doi:10.1291/hypres.30.999

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Keywords

  • renal artery stenosis
  • fibromuscular dysplasia
  • hypertension
  • angiotensin
  • angioplasty

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