Cutting Balloon Angioplasty for Resistant Pediatric Renal Artery Stenosis: A Single Institutional Experience

To assess the results of the adjunctive use of cutting balloon angioplasty (CBA) in the management of conventional balloon resistant renal artery stenosis (RAS) in terms of blood pressure control and renal growth.

Patients aged <21 years with renovascular hypertension who underwent angioplasty and CBA were reviewed. Thirty patients (male, 70%; median age, 7.5 years [interquartile range {IQR}, 5.7-12.5 years]) underwent 35 treatment episodes. Fifty-seven percent had fibromuscular dysplasia (FMD), 23% had FMD + midaortic syndrome (MAS), and 20% had neurofibromatosis type 1 ± MAS. Clinical and follow-up data were reviewed. Renal artery sizing was calculated from the diameter of the normal portion of the involved artery or the contralateral normal renal artery. In patients with persistent stenosis despite optimal sized balloon angioplasty, CBA was performed.

In total, 37 stenoses were targeted, 6 had prior balloon angioplasty in a separate treatment. Technical success (traversal of stenosis) rate was 89% (33/37). Angioplasty improvement (>30% stenosis improvement) rate was 94% (31/33). There was no significant relationship between technical failure, angiographic failure, and stenosis location/length or syndrome. The adverse event (AE) rate was 16% (6/37), with 2 moderate (segmental and subsegmental thrombus) and 2 severe (pseudoaneurysm and arterial perforation) cases. Clinical benefit rate at median follow-up of 59 months (IQR, 37-95 months) was 83% (25/30).

CBA offers a promising alternative for the management of resistant RAS, is technically feasible, and demonstrates clinical benefit. However, the observed AEs underscore the need for careful patient selection.