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Atherosclerotic renal artery stenosis: ostial or truncal?
R Kaatee1, F J Beek, E J Verschuyl
1Department of Radiology, University Hospital Utrecht, The Netherlands.
Insights
Digital subtraction angiography (DSA) may misdiagnose ostial renal artery stenoses as truncal, especially in patients with severe aortic atherosclerosis. Spiral computed tomography (CT) angiography offers a more accurate location assessment for these renal artery lesions.
Area of Science:
- Radiology
- Vascular Imaging
- Medical Diagnostics
Background:
- Renal artery stenosis is a significant cause of secondary hypertension.
- Accurate localization of renal artery stenosis is crucial for effective treatment planning.
- Discrepancies in lesion location between imaging modalities can impact patient management.
Purpose of the Study:
- To evaluate discrepancies in the reported location of renal artery stenoses between intraarterial digital subtraction angiography (DSA) and spiral computed tomography (CT) angiography.
- To identify factors contributing to these discrepancies.
Main Methods:
- Retrospective analysis of spiral CT angiograms and DSA images from 40 patients with atherosclerotic renal artery stenoses.
- Classification of stenoses as truncal or ostial.
- Grading of atherosclerotic changes in the abdominal aorta.
Main Results:
- Fifty-eight renal artery stenoses were analyzed.
- No location discrepancies were found for 48 ostial stenoses between CT angiography and DSA.
- In 10 cases, CT angiography identified ostial lesions, while DSA suggested truncal lesions ('pseudotruncal' ostial stenoses).
- These discrepancies were more common in patients with severe aortic atherosclerosis.
Conclusions:
- Intraarterial DSA may misclassify ostial renal artery stenoses as truncal, particularly when the stenosis is near an atherosclerotic aorta (within 10 mm).
- Severe aortic atherosclerosis is associated with an increased likelihood of pseudotruncal ostial stenoses on DSA.
- Spiral CT angiography may provide more accurate localization of renal artery stenoses in the context of significant aortic disease.
Purpose:
To evaluate a discrepancy between the location of renal artery stenoses on intraarterial digital subtraction angiographic (DSA) images and that on spiral computed tomographic (CT) angiograms.
Materials And Methods:
The spiral CT angiograms and intraarterial DSA images of 40 consecutive patients with atherosclerotic renal artery stenoses were examined retrospectively. Stenoses were classified as truncal or ostial. The atherosclerotic changes in the abdominal aorta were graded.
Results:
Fifty-eight stenoses were demonstrated. In 48 ostial stenoses, there was no discrepancy in the location of the stenoses on spiral CT angiograms and DSA images. In 10 patients, spiral CT angiography showed an ostial lesion, whereas DSA demonstrated an apparent truncal lesion. Most of these stenoses ("pseudotruncal" ostial stenoses) were in patients with severe aortic atherosclerotic disease.
Conclusion:
A renal artery stenosis at or within 10 mm of an atherosclerotic aorta at DSA may be diagnosed as an ostial stenosis.