Clinical perspective on renal artery stenosis: A single-center experience

The aim of this paper is to evaluate the effectiveness of percutaneous angiographic stenting in carefully selected, symptomatic patients diagnosed with hemodynamically significant atherosclerotic renal artery stenosis (ARAS) followed in our clinic.

This retrospective study included 69 patients who underwent renal artery stenting due to renal artery stenosis between 2011 and 2023 in our clinic. Demographic, clinical, and laboratory data were retrospectively retrieved from the hospital's electronic health records. Duplex ultrasonography (DU) was used as the primary screening tool; however, the decision to stent was made only after confirmatory catheter angiography demonstrated ≥ 60% stenosis with an anatomically treatable lesion in a clinically high-risk context (resistant hypertension, acute kidney injury/acute-on-chronic kidney disease, or flash pulmonary edema). Laboratory parameters, blood pressure levels, and antihypertensive medication requirements were compared at baseline and 1 month following the procedure.

Over the 12-year study period, 69 patients underwent renal artery stenting involving a total of 86 renal arteries. Of these patients, 31 (44.9%) were female, and the mean age was 65.75 years (SD = 10.75; range = 41 - 87 years). Conventional angiography was performed in 51 patients (73.9%), while carbon dioxide angiography was utilized in 18 patients (26.1%). All 69 patients underwent simultaneous stent placement during angiography. One month post procedure, urea and creatinine levels decreased in these patients; notably, among 20 patients who presented with acute kidney injury, creatinine levels returned to normal in 11 patients (55%) at 1-month follow-up. Additionally, in 6 out of 12 patients (50%) with acute exacerbations of chronic kidney disease, creatinine levels reverted to baseline. Pulmonary edema, observed in 16 patients (23.2%) at presentation, resolved completely in all affected patients 1 month after the intervention. The reduction rates in systolic blood pressure (SBP) and diastolic blood pressure (DBP) 1 month post procedure were 23.28 ± 11.67% and 20.48 ± 12.49%, respectively, both statistically significant (for SBP: p = 7 × 10^-13, effect size r = 0.868, matched-pairs rank-biserial correlation r_rb = -1; for DBP: p = 5.4 × 10^-12, effect size r = 0.869, matched-pairs rank-biserial correlation r_rb = -1). The mean number of antihypertensive medications significantly decreased from baseline to 1 month after renal artery stenting (mean ± SD: 3.36 ± 1.37 vs. 2.10 ± 1.12; Wilcoxon signed-rank test, V = 1.693, p < 0.001, effect size r = 0.85 > 0.50).

Intervention with stent placement in symptomatic/high-risk ARAS patients presenting with resistant hypertension, acute kidney injury, or flash pulmonary edema associated with significant renal artery stenosis can result in clinical improvement and a reduction in antihypertensive medication requirements, even within a short follow-up period of 4 weeks. Given the retrospective design, lack of a control group, and short follow-up, these findings should be interpreted as association rather than causation and cannot address long-term outcomes (e.g., restenosis, durable renal preservation, or cardiovascular events).