Renal artery stenting for renal artery stenosis: interventional approach and initial clinical results

Significant renal artery stenosis is being increasingly diagnosed and interventional cardiologists are taking on the unfamiliar role of deploying renal stents. We describe our technique for renal artery stenting using techniques and equipment similar to that used in coronary stenting and present early results.

Thirty-two patients with significant renal artery stenosis (diameter stenosis 60-95%) and difficult to control hypertension or renal impairment were referred for renal stenting. Renal DTPA scans were performed before intervention. All the procedures were attempted from the femoral artery approach using guides, low profile wires and balloon catheters similar to those used for coronary work. The lowest profile renal or coronary stents were deployed using a monorail technique.

Atherosclerosis was the cause of the renal artery stenosis in 31 patients. Stents were successfully deployed in 30 of these patients (97%). One patient required a second procedure from the brachial artery approach. An additional patient with fibromuscular dysplasia underwent angioplasty only. Angiographic diameter stenosis was reduced from a mean of 79 to 1%. Translesional mean pressure gradients were reduced from 22 to 1mmHg. There were no major procedural or in-hospital complications. Anti-hypertensive drugs were reduced from a mean of 3 prior to stenting to 0.7 at discharge. Renal DTPA scans were a poor predictor of severity of stenosis. Renal DTPA scans suggested functionally significant renal artery stenosis in only 48% of patients but the clinical responses suggested that this was an underestimate.

Stenting of renal arteries using coronary like techniques and equipment results in a high rate of procedural success and good early clinical outcomes.