Endovascular stent placement and magnetic resonance angiography for management of hypertension and renal artery occlusion during pregnancy.

Abstract

Severe renovascular hypertension carries serious maternal and fetal risk. In patients failing medical therapy, therapeutic options include surgical revascularization, nephrectomy, and percutaneous angioplasty. A pregnant woman with long-standing hypertension developed accelerated hypertension despite multiple drug therapy. Magnetic resonance angiography diagnosed an atrophic kidney with a critical proximal right renal artery lesion. At 17 weeks' gestation, this renal artery occlusion was treated with percutaneous angioplasty and endovascular stent placement; hypertension has improved markedly, allowing discontinuation and tapering of her antihypertensive medications. Total fetal radiation dose was 0.002 Gy. Magnetic resonance angiography is a promising, noninvasive diagnostic method of evaluating renovascular hypertension during pregnancy. Transluminal angioplasty and endovascular stent placement can be performed safely and effectively with nominal fetal radiation exposure.