経皮的腎動脈形成術にて加療した腎血管性高血圧の2例—血管内超音波とプレッシャーワイヤーの有用性について

Renovascular Hypertension Managed by Percutaneous Transluminal Renal Angioplasty Evaluating with Intravascular Ultrasound and Pressure Wire

　腎血管性高血圧症（RVH）の成因は年齢などによって異なっている．今回われわれは，若年者と中年者のRVHを経験し興味ある知見を得たので報告する．症例1は24歳，男性．頭痛を訴え，レニン活性の高値，左腎動脈に99％狭窄を認め，経皮的腎動脈形成術（PTRA）を施行した．症例2は57歳，男性．難治性高血圧で，レニン活性の上昇，左腎動脈に99％狭窄を認め，PTRAを施行した．血管内超音波検査（IVUS）で，症例1は輝度の増強は軽度で，線維筋異形成が，症例2は全周性に輝度の増強を認め動脈硬化性変化が考えられ，いずれもPTRA後良好な拡張を確認し得た．プレッシャーワイヤー（PW）にて，両例ともにPTRA術中に速やかに圧較差の是正を認め，その効果を判定できた．PTRAはRVHの治療法として有用であり，狭窄病変の形態評価にはIVUSが，術中治療効果の判定にはPWが有用であった．

We reported two cases of renovascular hypertension, one in a young man and the other in a middle-aged man.

Case 1 : A 24-year-old man had headache and showed a high level of plasma renin activity. His angio-graphy revealed a 99% stenosis of the left renal artery, so we performed percutaneous transluminal renal angio-plasty (PTRA) on him.

Case 2 : A 57-year-old man had hypertension that was drug-resistant, and his plasma renin activity had increased. His renal angiogram showed a PTRA to 99% stenosis of the left renal artery, and we performed PTRA to the stenosis.

By intravascular ultrasound (IVUS), the echogenic appearance of the intima and media of the case 1 stenotic lesion was suspected to be fibromuscular dysplasia (FMD). On the other hand, the diffuse high-echoic intima in case 2 was suspected to he atheroscle-rosis.

During the PTRA of both cases, the pressure gradient at the stenosis became normalized immediately with to use of the pressure wire, which was evidence of a suc-cessful result.

In conclusion, IVUS can easily evaluate the etiology of the stenotic lesion and pressure wire can determine the effectiveness of PTRA in patients with RVH.