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Renal artery stenosis treated with stent deployment: indications, technique, and outcome for 108 patients
J A Rodriguez-Lopez1, A Werner, L I Ray
1Arizona Heart Institute, 2632 N 20th Street, Pheonix, 85006, USA.
Insights
Percutaneous transluminal angioplasty with stent deployment effectively treats renal artery stenosis and renovascular hypertension. While it improved hypertension in 68% of patients, it did not significantly alter renal function.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Interventional Radiology
Background:
- Renal artery stenosis (RAS) is a significant cause of renovascular hypertension and progressive renal failure.
- Atherosclerotic lesions are the primary cause of RAS in the elderly population.
- Treatment aims to restore renal blood flow and improve or cure hypertension and renal function.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of percutaneous transluminal angioplasty (PTA) combined with stent implantation for atherosclerotic renal artery stenosis.
- To assess the impact of PTA and stenting on renovascular hypertension and renal function.
- To determine the procedural success rates, complication rates, and long-term patency.
Main Methods:
- A retrospective analysis of 108 patients who underwent 125 PTA and stent procedures for atherosclerotic renal artery stenosis between January 1993 and May 1996.
- Patients were treated for renovascular hypertension, or a combination of hypertension and renal failure.
- Outcomes were assessed by blood pressure control, serum creatinine levels, procedural success, complications, and long-term patency rates via duplex scanning and angiography.
Main Results:
- Procedural success was achieved in 97.6% of cases.
- Renovascular hypertension was cured or improved in 68% of patients; 13% were cured (normotensive without medication).
- No statistically significant improvement in serum creatinine levels was observed.
- Complications occurred in 7.2% of cases, with a 30-day mortality rate of 3.7%.
- Life-table analysis showed a 74% primary patency rate and 85% secondary patency rate at 36 months.
Conclusions:
- Combining PTA with stent deployment is an effective treatment for significant atherosclerotic renal artery stenosis, leading to significant improvement in renovascular hypertension.
- While effective for hypertension, this combined approach did not demonstrate a significant benefit in improving renal function (serum creatinine levels).
- Long-term patency rates are favorable, supporting the role of this intervention in managing RAS.
Abstract:
From January 1993 to May 1996, 108 patients (64 men, 44 women; mean age, 72 years; age range, 37 to 87 years) underwent 125 percutaneous transluminal angioplasties and stent implantations primarily for atherosclerotic lesions of the renal artery. Sixty-four patients underwent treatment for renovascular hypertension (two antihypertensive medications or more), 32 patients underwent treatment for a combination of hypertension and renal failure (serum creatinine level >/=1.6 mg/dL), and a small group of six patients (5%) without hypertension or diminished renal function underwent treatment to prevent the progression to renal artery occlusion and kidney loss. Thirty-three patients (31%) had renovascular hypertension that was classified as severe on three or more medications, 31 patients (29%) had renovascular hypertension that was classified as moderate on two medications, and 38 patients (35%) had renovascular hypertension that was classified in the mild group on a single antihypertensive agent. Stenotic lesions were located at the ostium of the renal artery in 82 cases (65%) and were ostial-adjacent (<5 mm from renal ostium) in the other 43 cases (34%). A total of 125 stents were deployed in 125 arteries (procedural success 97.6%). Renovascular hypertension either was cured or was improved in 73 patients (68%), with 14 patients (13%) considered cured (normotensive on no medications). The conditions of 29 patients (27%) were unchanged, and 6 patients (5%) had worsening hypertension after surgery. We were unable to demonstrate a statistically significant improvement in serum creatinine levels after renal artery balloon angioplasty/stenting. Complications occurred in a total of nine cases (7.2%), six of which were related to technical problems. One patient had worsening renal insufficiency caused by contrast agent, and another patient had a perinephric hematoma develop that necessitated evacuation. There were four postoperative deaths (30-day mortality). Two of these deaths were caused by postoperative myocardial infarction. The other two patients had progressive renal failure develop that necessitated dialysis. These patients later died of the disease process despite supportive care. Follow-up renal artery duplex scan studies and angiograms were available on 96 patients (76%). The mean peak systolic renal/aortic ratio on duplex scanning was 2.2. Life-table analysis yielded a 74% primary patency rate and an 85% secondary patency rate at 36 months. This retrospective analysis showed the effectiveness of combining percutaneous transluminal angioplasty with stent deployment for significant renal artery stenosis to treat renovascular hypertension.