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Percutaneous revascularization of the renal arteries: predictors of outcome
M F Giroux1, G Soulez, E Thérasse
1Department of Radiology, CHUM-Notre-Dame Hospital, Montreal, Quebec, Canada.
Insights
Predictors of successful renal artery revascularization include clinical factors for hypertension and Doppler sonography for renal failure. These findings aid in optimizing treatment outcomes for patients with renal artery stenosis.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Interventional Radiology
Background:
- Renal artery stenosis (RAS) is a significant cause of secondary hypertension and progressive renal failure.
- Percutaneous revascularization is a common treatment for RAS, but predicting outcomes remains crucial.
Purpose of the Study:
- To identify predictors of clinical success following percutaneous revascularization of the renal arteries.
- To evaluate the role of clinical and imaging factors in predicting outcomes for hypertension and renal failure secondary to RAS.
Main Methods:
- Retrospective analysis of 63 patients undergoing percutaneous transluminal renal angioplasty (PTRA) with or without stenting for RAS.
- Assessment of clinical and imaging data, including Doppler sonography, angiography, and scintigraphy, to identify outcome predictors.
Main Results:
- For hypertension, predictors of success included shorter duration of hypertension, higher diastolic blood pressure, fibromuscular dysplasia, abnormal Doppler, higher stenosis percentage, and less aortic disease.
- For renal failure, predictors of success were nondiabetic status, abnormal Doppler, and higher stenosis percentage.
- Abnormal Doppler and scintigraphy predicted successful treatment for hypertension in 60% and 53.8% of cases, and for renal insufficiency in 85% and 60% of cases, respectively.
Conclusions:
- Clinical and angiographic variables are key predictors for successful hypertension treatment in RAS.
- Doppler sonography is a valuable tool for predicting outcomes in patients with renal failure due to RAS.
Purpose:
To identify predictors of clinical outcome after percutaneous revascularization of the renal arteries.
Materials And Methods:
In 63 patients, the therapeutic response was retrospectively assessed after percutaneous revascularization of the renal arteries indicated for hypertension (41.3%), renal failure (4.8%), or both (53.9%). All patients underwent percutaneous transluminal renal angioplasty, complemented by stent insertion in 30 patients. The authors analyzed the role of clinical and imaging factors, including scintigraphy, Doppler sonography, and angiography for predicting clinical success.
Results:
In the hypertensive population, there were three cures (5.6%), 26 improvements (48.1%), and 25 failures (46.3%). Among patients with renal insufficiency, 12 were improved (37.5%), 11 were stabilized (34.4%), and nine deteriorated (28.1%). Predictors of favorable outcome for hypertension were shorter duration of hypertension, higher diastolic blood pressure, fibromuscular dysplasia, abnormal Doppler study, higher percentage of angiographic stenosis, and lower grade of aortic atheromatous disease. Predictors of favorable outcome for renal failure were nondiabetic status, abnormal Doppler study, and higher percentage of angiographic stenosis. Abnormal Doppler and scintigraphic examinations predicted successful treatment of hypertension in 60% and 53.8% of cases, respectively, and renal insufficiency in 85% and 60% of cases, respectively.
Conclusion:
Clinical and angiographic variables were the best predictors of therapeutic success for hypertension. Doppler sonography was useful in patients with renal failure.