Zastosowanie niepodatnych balonów techniką hugging balloons do skutecznego rozprężenia stentu po niepowodzeniu rutynowej przezskórnej śródnaczyniowej angioplastyki tętnic wieńcowych

A small portion of lesions are refractory even when very high pressures are used to deploy the stent. Here, we report a 7-years old boy referred for evaluation of refractory hypertension. There was a bruit on auscultation on the back in lumber region. Renal angiogram revealed bilateral renal artery stenosis. Right and left renal arteries were stented with 7x23 mm and 7x19 mm Hippocampus bare metal stent (Medtronic, USA). Despite delivering stent in left renal artery at 10 atm pressure, it didn’t open up properly. We successfully attempted the technique of hugging balloons or two noncompliant balloons- 4x10 mm each, inflated simultaneously side by side at 20 atm to successfully dilate the stent. This technique enables success as the geometry of two kissing balloons is different from one balloon. This altered geometric configuration may be important in successfully dilating a stent refractory to standard dilating techniques. Higher pressures can be attained with two smaller balloons as the burst pressure is higher in smaller balloons compared to larger balloons.