Acute renal artery embolism treated with a cardiac thrombectomy catheter

Renal artery embolism (RAE) is an uncommon but important cause of renal function loss in patients with valvular or aneurysmal cardiac disease, arrythmia or aortic atherosclerosis. Clinical diagnosis is often difficult and further invasive tests are required. Traditionally RAE has been treated with either surgical embolectomy or local thrombolysis.

A 68-year-old man with a history of previous coronary artery bypass grafting was admitted with unstable angina for cardiac catheterisation. Before the procedure he developed acute right-sided abdominal and lumbar pain associated with hypotension and oliguria. Urine analysis was positive for protein and blood. An ECG showed new atrial fibrillation. A transthoracic echocardiogram showed a left ventricular apical aneurysm with thrombus. A CT scan performed within 2 hours of pain confirmed the diagnosis of acute right renal artery occlusion (panel A). Through the right common femoral artery a 5 French Export aspiration catheter (Medtronic Vascular, Santa Rosa, CA, USA) was used to aspirate the right renal artery thrombus (panel B). There was no underlying stenotic lesion. No long-term deterioration in renal function was seen. We believe this is the first case of acute RAE treated percutaneously with a thrombus aspiration catheter.

Figure 1. (A) Renal angiogram showing thrombotic occlusion of the right renal artery. (B) Renal angiogram showing unobstructed right renal artery after successful percutaneous thrombus aspiration.