Abstract
A patient with previous implantation of two stents in the left renal artery (because of refractory arterial hypertension) developed, 7 months after implantation, a renal infarction due to late renal stent thrombosis. The early diagnosis by means of computed tomography of the abdomen and the rapid intervention by means of percutaneous balloon angioplasty lead to a favorable outcome.
A 54 year-old patient was admitted to the emergency department of a peripheral hospital in July 2008 because of nausea, vomiting, and acute pain in the left flank. He had a previous history of percutaneous transluminal angioplasty (PTA) of the left iliac artery in 2004 and PTA with two overlapping stents in the ostium of the left renal artery in December 2007 due to refractory hypertension (the ostial stent had a diameter of 5 mm and a length of 19 mm, while the distal stent had a diameter of 7 mm and a length of 12 mm) The patient was taking aspirin, a beta-blocker, and a statin, while he stopped clopidogrel 1 month before the current admission. Clinical examination showed a febrile patient (37.5°C) with high blood pressure (210/120 mmHg) and tachycardia (101 beats/min). His abdomen was painful at palpation, with peritoneal reaction, mainly localized in the epigastrium and in the left fossa. Blood values showed a mildly elevated renal function (creatinine: 1.63 mg/dl), elevated inflammatory parameters (C-reactive protein: 1.1 mg/dl and leucocytosis: 18 000/mm 3 ), and an elevated lactate dehydrogenasis (4222 U/l). A computed tomography of the abdomen with contrast revealed an absence of perfusion of the left kidney with contrast stasis in the stent ( Fig. 1 A ).
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