Refractory hypertension secondary to renal artery stenosis with a honeycomb-like structure

• Published in: BMC cardiovascular disorders Vol. 21; no. 1; p. 606
• Main Authors: Chen, Cheng, Zhang, Ying, Yin, Da, Liu, Yan, Cheng, Yunpeng, Lu, Yan, Jiang, Yinong, Song, Wei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20-12-2021; BioMed Central; BMC
• Subjects: Aged; Angiography; Angioplasty, Balloon - instrumentation; Antihypertensive drugs; Atherosclerosis; Balloon treatment; Blood clots; Blood flow; Blood pressure; Cardiac catheterization; Care and treatment; Case Report; Case studies; Catheters; Complications and side effects; Coronary artery; Coronary vessels; Creatinine; Diabetes; Dosage and administration; Honeycomb-like structure; Humans; Hypertension; Hypertension, Renovascular - diagnosis; Hypertension, Renovascular - etiology; Hypertension, Renovascular - physiopathology; Hypertension, Renovascular - therapy; Implants; Infarction; IVUS; Kawasaki disease; Male; Medical imaging; Methods; Renal artery; Renal Artery - abnormalities; Renal Artery - diagnostic imaging; Renal Artery - physiopathology; Renal artery obstruction; Renal Artery Obstruction - complications; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - physiopathology; Renal Artery Obstruction - therapy; Renal artery stenosis; Risk factors; Secondary hypertension; Stenosis; Stents; Thrombosis; Tomography; Treatment Outcome; Ultrasonic imaging; Ultrasonography, Interventional; Veins & arteries; China; IVUS; Case report; Renal artery stenosis; Secondary hypertension; Honeycomb-like structure
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02428-1

A honeycomb-like structure (HLS) is a rare abnormality characterized by a braid-like appearance. Angiograph and intravascular examination, including coherence tomography and intravascular ultrasound (IVUS), can further confirm the multiple intraluminal channels or honeycomb structure, which can also be described as looking like 'swiss cheese', a 'spider web' or a 'lotus root'. Previous studies have mostly reported this abnormality in coronary arteries, with a few cases in renal arteries. More information about the characteristics and development of HLS is needed.
A 69-year-old Han man with resistant hypertension received abdominal enhanced computerised tomography and was revealed to have left renal artery stenosis with the possibility of left renal infarction. Renal artery angiography confirmed a 95% stenosis located in the proximal segment of the left renal artery, and the middle segment was blurred with multi-channel-like blood flow. Further IVUS was performed and identified multiple channels surrounded by fibrous tissue. It was a rare case of HLS in the renal artery secondary to the thrombus, with organisation and recanalisation. Balloon dilatation and stent implantation at the proximal segment of the left renal artery were performed successfully. Blood pressure was well controlled after the procedure.
The IVUS findings are helpful for forming interventional therapeutic strategies for HLS lesions in the renal artery.