Severe acute renal artery catheter-induced spasm simulating organic stenosis in a patient with uncontrolled hypertension, renal disease, and an accessory renal artery

SESSION TITLE: Critical Care Case Report Posters 35 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Catheter-induced vasospasm is produced by mechanical stimulation of a vessel by contact with a catheter. Catheter-induced vasospasm of small caliber arteries, such as the coronary arteries, is frequently observed during cardiac catheterization. Obstruction of the peripheral, bigger arteries such as renal artery is extremely rare. We present a case of hypertensive emergency caused by uncontrolled hypertension in an end stage renal disease patient, whose first renal angiogram showed critical left renal artery stenosis. CASE PRESENTATION: 63 year old female with uncontrolled hypertension and end stage renal disease on hemodialysis (HD) was admitted with blood pressure (BP) 211/104mmhg and elevated high sensitivity troponin (HST) of 3000. Her stress test was abnormal last month. Renal angiogram was requested by nephrology due to uncontrolled hypertension. Coronary and renal angiograms were performed, which showed mid and distal left anterior descending artery lesions (were treated with stents) and 99% stenosis of the ostial left renal artery. Renal angiogram was then performed again for possible stent placement since BP remained elevated and was thought to be due to renal artery stenosis. As the catheter was advanced, vasospasm was visibly noted in the left renal artery and Nifedipine was injected, which improved vasospasm. No renal stents were placed. However, an accessory left renal artery was also seen. DISCUSSION: She was started on Amlodipine in addition to other medications and BP was noted to be better controlled and HST trended down. She was asked to be compliant with HD schedule and medications. CONCLUSIONS: Severe localized renal artery spasm can angiographically mimic organic stenosis and should therefore be considered as a differential diagnosis, while performing primary percutaneous renal artery interventions, to avoid erroneous diagnosis. Whether patients with end stage renal disease on HD and/or have accessory renal arteries have higher risks of catheter induced artery vasospasm needs to be investigated. This case illustrates the potential challenges in diagnosing catheter-induced vasospasm from fixed obstructive atherosclerotic lesions in peripheral arteries. REFERENCE #1: Sueda, S., Fujimoto, K., Sasaki, Y., Sakaue, T., Habara, H., & Kohno, H. (2019). Catheter-induced spasm in the proximal right coronary artery. Internal Medicine, 58(1), 21-30. REFERENCE #2: Esenboga, K., Baskovski, E., Ozyuncu, N., & Tutar, E. (2020). Catheter-induced multiple non-proximal coronary spasm in a patient presenting with myocardial infarction. Cureus. DISCLOSURES: No relevant relationships by Ahsan Khan No relevant relationships by Dilesha Kumanayaka No relevant relationships by Kinjal Patel No relevant relationships by Addi Suleiman