ArticleEuropean heart journal. Case reports2025
Usefulness of intervention using interlesion pressure ratio in renal artery stenosis due to multifocal fibromuscular dysplasia: a case report.
Article in European heart journal. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Renal artery stenosis (RAS) due to fibromuscular dysplasia (FMD) is a known cause of secondary hypertension. Percutaneous transluminal renal angioplasty (PTRA) is an established treatment. However optimal procedural endpoints remain controversial. The Pd/Pa ratio-the mean distal renal artery pressure (Pd) to the mean aortic pressure (Pa)-has been proposed to guide interventions, its role as an endpoint remains to be validated. This report describes the clinical utility of the Pd/Pa ratio in our patient. Case summary: A 36-year-old Asian woman presented with incidentally diagnosed hypertension (185/115 mmHg). Medical and family history were unremarkable. Despite antihypertensive therapy with ARB and calcium channel blocker-measured blood pressure (BP) remained uncontrolled. Renal ultrasonography revealed a high peak systolic velocity in the right renal artery, and 3D-CT angiography revealed early bifurcation of the right renal artery and suspected stenosis in the lower pole branch. Angiography confirmed multifocal (beaded) stenosis, typical of FMD. The pre-procedural Pd/Pa ratio was 0.44. Percutaneous transluminal renal angioplasty was performed using two balloon sizes without stenting. Despite slight angiographic changes, the post-procedural Pd/Pa ratio improved to 0.84. At 1-year follow-up, BP was well-controlled with monotherapy and renal Doppler findings normalized. Discussion: This case demonstrates the clinical utility of Pd/Pa ratio as a physiological endpoint in PTRA for FMD-related RAS. Multifocal FMD, angiographic assessment may underestimate haemodynamic improvement; however, a substantial increase in the Pd/Pa ratio, even below the conventional 0.90 threshold, may indicate procedural success. Applying the Pd/Pa ratio may avoid stenting in small-calibre vessels and favour long-term BP control.
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