Renal artery PTA and stent implantation: immediate and late clinical and morphological outcome

Renal artery stenosis (RAS) is a potentially curable cause of secondary hypertension, but the indications for interventional treatment of renovascular hypertension are still a matter of debate. The aim of the study was to investigate immediate and long-term results of percutaneous renal artery revascularization (PTRA). Primary technical success, peri-intervention complications, patency, the course of arterial hypertension and renal function were analyzed.

32 renal interventions in 24 consecutive patients (15 PTA, 17 stents) were investigated in a retrospective cohort study. Comorbidities, interventional data and serum creatinine were recorded. Patients were followed for a median period of 45 months (IQR, 32 to 68). Clinical evaluation of the course of blood pressure, serum creatinine, Doppler ultrasound evaluation and multi-slice spiral-CT angiography were performed at follow-up.

Primary technical success was achieved in 30 interventions (94%), and in 2 patients during a secondary intervention. The rate of complications was 16% (n = 5). Three major complications were encountered (9%): 1 renal artery thrombosis and 2 acute renal failures. Three patients developed late renal failure after 1, 4 and 37 months, but the overall serum creatinine levels remained stable during the observation period. Hypertension was improved after intervention in 17 patients (71%). However, recurrent hypertension was found in 9 patients (38%) after a median period of 49 months (IQR, 47 to 96). Patency rates at 12, 24 and 72 months were 94%, 94% and 64%, respectively.

Renal artery PTA can be performed with an acceptable rate of major complications and good long term morphological results. However, clinical outcome in terms of sustained improvement of hypertension is moderate.