Successful revascularization of chronic total renal artery occlusion in a young patient with resistant hypertension and renal dysfunction: a case report

Randomized clinical trials have shown no overall advantage of renal artery revascularization over optimal medical therapy in unselected populations with renal artery stenosis. However, these findings may not be generalizable to all patient subgroups. Carefully selected individuals with high-risk features may still derive substantial clinical benefit from revascularization.

A 29-year-old woman presented with severe resistant hypertension despite treatment with four antihypertensive agents and strict adherence to lifestyle modifications. Laboratory investigations revealed newly developed renal dysfunction with a significant reduction in estimated glomerular filtration rate compared with prior normal values. Renal Doppler ultrasonography demonstrated chronic total occlusion of the right renal artery, which was subsequently confirmed by computed tomography angiography and invasive renal angiography. Despite complete arterial occlusion, renal size was preserved, and collateral perfusion via the suprarenal artery was evident. Technetium-99 m dimercaptosuccinic acid scintigraphy confirmed viable renal parenchyma, indicating potential reversibility of ischaemic injury. Given persistent uncontrolled blood pressure, progressive deterioration of renal function, and preserved renal viability, percutaneous renal artery revascularization was undertaken. The occluded segment was successfully revascularizated by stent implantation, resulting in complete restoration of arterial patency. Blood pressure normalized promptly after the procedure, allowing significant down-titration of antihypertensive therapy. Renal function improved markedly within 2 weeks and remained stable during long-term follow-up.

Chronic total renal artery occlusion does not invariably reflect irreversible renal damage. In selected patients with preserved renal anatomy, collateral circulation, and viable parenchyma, endovascular revascularization may lead to sustained improvements in blood pressure control and renal function.