Percutaneous cutting balloon angioplasty safe, effective in kids with renovascular hypertension

Percutaneous cutting balloon angioplasty (PCBA) is both effective and well-tolerated in the treatment of hypertensive children and adolescents with recurrent or resistant renal artery stenosis, suggests a recent study.

In addition, PCBA may be considered as an alternative to percutaneous transluminal renal angioplasty (PTRA), which is the recommended treatment in children with renovascular hypertension (RVH).

A team of investigators retrospectively analysed the effects of PCBA on blood pressure, cardiac mass, and renal artery acceleration time in children/adolescents with RVH. They identified 13 patients (aged 9‒19 years) with renal artery stenosis and severe hypertension.

Of the patients, 10 had uncontrolled hypertension and nine were associated with left ventricular hypertrophy. Acceleration time was abnormal in all stenotic arteries. A total of 18 PCBAs were performed among patients, including three arteries associated with stent implantation.

PCBA was a success in all patients, with no major complications reported. One patient had intrastent restenosis, which was effectively redilated with conventional angioplasty without recurrence at 4 years.

Systolic and diastolic blood pressure significantly decreased a year after PCBA, from 146 to 121 mm Hg and 87 to 65 mm Hg, respectively (p<0.001 for both). During the same period, seven children were cured of hypertension and five had their condition under control.

“This favourable outcome was confirmed with ambulatory blood pressure measurement in four patients,” the investigators said. “At the latest follow-up, left ventricular mass and acceleration time were normal in all patients.”