Renal Frame Count and Renal Blush GradeQuantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis
Ehtisham Mahmud, MD, FACC*,
Thomas W.R. Smith, MD,
Vachaspathi Palakodeti, MD, FACC,
Owais Zaidi, MD,
Lawrence Ang, BS,
C. Robinson Mitchell, MD,
Nayab Zafar, MD,
Guilherme Bromberg-Marin, MD,
Shahin Keramati, MD, FACC,
Sotirios Tsimikas, MD, FACC
Division of Cardiovascular Medicine, School of Medicine, University of California, San Diego, San Diego, California.
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Figure 1 RFC
A series of still frame images obtained at 30 frames/s showing an example of obtaining the renal frame count (RFC) (frame 1, 5, 10, 15, 20, and 25 from left to right). The first frame is counted with complete transverse opacification of the renal artery, with the final frame being the identification of a cortical vessel in a relatively straight line; this subject had a renal frame count of 18.
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Figure 2 RBG
Examples of renal blush grade (RBG). (A) Grade 0: no parenchymal blush/contrast opacification of cortical vessels or inability of contrast clearance from renal parenchyma after initial opacification; (B) grade 1: minimal parenchymal blush/contrast opacification of cortical vessels; (C) grade 2: complete parenchymal blush/contrast opacification of cortical vessels; (D) grade 3: hyperemic parenchymal blush/brisk clearance of contrast from cortical vessels. All assessments made within the first 2 s of initial contrast opacification of the renal artery (frame 60).
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Figure 3 RFC and RBG in the Control and Study Groups
The RFC (A) and RBG (B) in the control group (n = 17; 22 kidneys) without renal artery stenosis, and in the study group (n = 24) before and after renal stenting for atherosclerotic renal artery stenosis. Note that after stenting both parameters approach levels similar to the control hypertensive population without renal artery stenosis. Data are shown as mean ± standard error of mean. Abbreviations as in Figures 1 and 2.
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Figure 4 Improvement in RBG After Renal Stenting
An example of improvement in RBG after renal stenting in a study subject. (A) RBG 1 assessed prior to stenting at frame 60; note the absence of parenchymal blush and cortical filling of vessels. (B) RBG 3 assessed after renal artery stenting at frame 60; note the clearance of contrast from the cortical vessels at the same time point. Abbreviation as in Figure 2.
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Figure 5 Blood Pressure Response in Study Group
Blood pressure response for the study group after renal stenting at 6-month clinical follow-up. DBP = diastolic blood pressure; MAP = mean arterial pressure; SBP = systolic blood pressure. Data are shown as means ± standard error of mean.
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Figure 6 RFC and Clinical Response
The RFC response of clinical responders (SBP reduction >15 mm Hg at 6-month follow-up). (A) Decrease in RFC after renal stenting for the clinical responders. Boxes with lines show medians with the interquartile range. (B) The proportion of clinical responders among patients with >4 renal frame count reduction after renal stenting. Abbreviations as in Figures 1 and 5.
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