Endovascular stent placement and magnetic resonance angiography for management of hypertension and renal artery occlusion during pregnancy

Background: Severe renovascular hypertension carries serious maternal and fetal risk. In patients failing medical therapy, therapeutic options include surgical revascularization, nephrectomy, and percutaneous angioplasty. Case: A pregnant woman with long-standing hypertension developed accelerated hypertension despite multiple drug therapy. Magnetic resonance angiography diagnosed an atrophic kidney with a critical proximal right renal artery lesion. At 17 weeks' gestation, this renal artery occlusion was treated with percutaneous angioplasty and endovascular stent placement; hypertension has improved markedly, allowing discontinuation and tapering of her antihypertensive medications. Total fetal radiation dose was 0.002 Gy. Conclusion: Magnetic resonance angiography is a promising, noninvasive diagnostic method of evaluating renovascular hypertension during pregnancy. Transluminal angioplasty and endovascular stent placement can be performed safely and effectively with nominal fetal radiation exposure.