Lots of interesting abstracts and cases were submitted for TCTAP 2022. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-148
The Masquerading Pickering; In-stent Restenosis of Renal Artery Stenting With Contralateral Renal Artery Stenosis Presenting With Flash Acute Pulmonary Edema
By Shawal Faizal Mohamad, Muhammad Shamill Bin Shamsul Ismail, Mohd Asyiq Al-Fard Bin Mohd Raffali, Noor Diyana Binti Mohamad Farouk, Rosli Mohd Ali, Hamat Hamdi Che Hassan
Presenter
Shawal Faizal Mohamad
Authors
Shawal Faizal Mohamad1, Muhammad Shamill Bin Shamsul Ismail1, Mohd Asyiq Al-Fard Bin Mohd Raffali1, Noor Diyana Binti Mohamad Farouk1, Rosli Mohd Ali2, Hamat Hamdi Che Hassan1
Affiliation
Hospital Canselor Tuanku Muhriz UKM, Malaysia1, Cardiac Vascular Sentral Kuala Lumpur, Malaysia2,
View Study Report
TCTAP C-148
ENDOVASCULAR - Peripheral Vascular Disease and Intervention
The Masquerading Pickering; In-stent Restenosis of Renal Artery Stenting With Contralateral Renal Artery Stenosis Presenting With Flash Acute Pulmonary Edema
Shawal Faizal Mohamad1, Muhammad Shamill Bin Shamsul Ismail1, Mohd Asyiq Al-Fard Bin Mohd Raffali1, Noor Diyana Binti Mohamad Farouk1, Rosli Mohd Ali2, Hamat Hamdi Che Hassan1
Hospital Canselor Tuanku Muhriz UKM, Malaysia1, Cardiac Vascular Sentral Kuala Lumpur, Malaysia2,
Clinical Information
Patient initials or Identifier Number
ZB
Relevant Clinical History and Physical Exam
A 60 year old lady presented to our emergency department with sudden onset of shortness of breath associated with chest discomfort at rest. She is a diabetic with history of coronary artery bypass graft in 2012 for ischemic heart disease and had right renal angioplasty in 2010 due to renal artery stenosis.On examination, she was tachypneic with respiratory rate of 28. Her blood pressure was 170/110 mm Hg with pulse rate of 100. Her lung examination showed bilateral crepitations up to mid zone.
Relevant Test Results Prior to Catheterization
Her ECG on arrival showed left ventricular hypertrophy. Chest radiography showed cardiomegaly with congested lung fields. Her serum creatinine jumped from 110 umol/L 2 months ago to 380 on admission.
Relevant Catheterization Findings
Coronary angiogram showed patent LIMA to LAD and patent RCA stent. In view of the non-significant findings of coronary vessels, we shifted our attention to her renovascular system. Her right renal artery stent showed 90 percent in-stent restenosis and left renal artery was severely stenosed at the proximal segment of the renal artery.
ZB coronary angiography and graft study.mp4
Right renal angiogram.mp4
ZB coronary angiography and graft study.mp4 Right renal angiogram.mp4Interventional Management
Procedural Step
Ultrasound of bilateral kidney showed shrunken right kidney (7.8cm) and normal size left kidney (11.2cm). Based on the investigations, a diagnosis of recurrent Pickering Syndrome with single functioning kidney is made. We proceed with angioplasty for her left proximal renal artery stenosis, by putting a BOSTON SCIENTIFIC EXPRESS VASCULAR SD 7x15mm stent. A filter wire inserted revealed some debris consistent with atherosclerotic plaques. Final result revealed good flow over the left renal artery.
Case Summary
A month after the procedure, her creatinine was back to baseline to 120 umol/L. She also felt better in terms of improved effort tolerance and reduced shortness of breath.This is a case of Pickering Syndrome as evident by the single functioning kidney with severe renal artery stenosis. A sizeable amount of case reports have described flash pulmonary edema usually manifested in patients with bilateral renal artery stenosis. In our case, as the right kidney has already shrunken, proceeding with angioplasty of the left renal artery will be the reasonable option to prevent future readmission of acute pulmonary edema. A large randomized control trial in the future will help to address this issue.