Intravascular ultrasound-mediated stent-assisted coil embolization and follow-up of a large renal artery aneurysm with ostial stenosis in a solitary kidney.

Objective: To describe an intravascular ultrasound (IVUS)-guided, stent-assisted coil embolization for a large renal artery aneurysm with ostial stenosis in a solitary kidney, and report outcomes over 2.5 years. Methods: A 46-year-old man with a prior left nephrectomy presented with resistant hypertension. Computed tomography angiography revealed a 3.8 × 3.9 cm saccular aneurysm of the right renal artery with ostial stenosis. Given the solitary kidney and poorly controlled hypertension, a branch-preserving endovascular approach was chosen. IVUS guided device selection and deployment. Results: Through femoral artery access, an 8 × 60 mm stent was deployed across the aneurysm neck and the ostial lesion, followed by postdilation angioplasty. Nineteen detachable coils were deployed through the stent interstices, achieving sac occlusion while preserving branch perfusion. Completion imaging showed preserved renal flow and complete aneurysm exclusion. During 36-month follow-up with ultrasound examination and IVUS, the stented segment remained patent after angioplasty for restenosis at 6 months. Blood pressure improved with fewer medications, and renal function remained stable. Conclusions: In patients with a solitary kidney and complex renal artery aneurysm, IVUS-guided stent-assisted coil embolization can achieve durable aneurysm exclusion while preserving renal function. Using an open-cell stent and IVUS guidance may optimize outcomes in challenging cases.