Modification of the No-Touch Technique during Renal Artery Stenting

Renal artery stenting has been established as the primary form of renal artery stenosis revascularization procedure. The no-touch technique is proposed in order to avoid renal artery injury and atheroembolism during renal artery stenting. We describe a modification of the no-touch technique by using an over-the-wire (OTW) balloon or a Quickcross catheter with a coronary wire inside, instead of the rigid ？J wire. The reported technique, while it prevents direct contact of the guiding catheter with the aortic wall, at the same time it allows for a closer contact with the renal arterial ostium and a more favorable guiding catheter orientation, compared to what is achieved with the use of the more rigid ？J wire, thus improving visualization, reducing the amount of contrast required, and potentially decreasing complications. 1. Introduction Renal artery stenting has been widely used for the treatment of renal artery stenosis. The technical aspects of stenting have improved over the last years, and procedural safety is recognized as of paramount importance. Two invasive techniques are proposed in order to avoid renal artery injury and atheroembolism during renal artery stenting [1]: the catheter-in-catheter and the so-called no-touch technique. The no-touch technique [2] uses a ？J wire inside the guiding catheter, to lift the tip off the aortic wall. With the wire in place, the guiding catheter is aligned with the renal artery, and a guidewire is used to cross the stenosis. The wire is then removed, and the guiding catheter is advanced over the wire to engage the renal artery. We report a modification of the no-touch technique by using an over-the-wire (OTW) balloon or a Quickcross catheter (Spectranetics) with a coronary wire inside, instead of the rigid ？J wire. 2. Case 1 A 67-year-old lady, with uncontrolled severe hypertension despite therapy, peripheral arterial disease (PAD), and left ventricular hypertrophy was diagnosed with right renal artery stenosis and referred for renal angiography. An abdominal aortogram confirmed the presence of significant right renal artery stenosis. Renal percutaneous transluminal angioplasty (PTA) was then undertaken. The procedural steps were as follows.(1)A 6F internal mammary artery (IMA) guiding catheter (Launcher, Medtronic) was introduced and was placed at the level of the right renal artery but pointed away of the right renal artery ostium, without touching the aortic wall.(2)A Balance (Abbott) coronary wire in a Quickcross catheter (Spectranetics) was introduced in the 6F guiding catheter with the tip of the wire