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Stent placement in the renal artery: three-year experience with the Palmaz stent
1Department of Cardiology and Interventional Surgery, Polyclinique D'Essey, Essey les Nancy, France.
Insights
Renal artery stent placement is effective for treating atherosclerotic renal-artery stenoses, improving patency rates. While beneficial for hypertension, it does not enhance renal function.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Nephrology
Background:
- Atherosclerotic renal artery stenosis (RAS) is a significant cause of secondary hypertension.
- Percutaneous transluminal renal angioplasty (PTRA) is a common treatment, but restenosis can occur.
- Stent placement offers a potential solution to improve long-term outcomes in RAS.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of renal artery stent placement.
- To assess the impact of stenting on restenosis rates and patency.
- To determine the effect of stent placement on blood pressure control and renal function.
Main Methods:
- A retrospective analysis of 64 renal artery stent placement procedures in 59 hypertensive patients from 1990-1994.
- Indications included residual stenosis post-PTRA, restenosis, and acute dissection.
- Follow-up included arteriography at 6 months and duplex ultrasound for long-term patency assessment.
Main Results:
- Technical success was achieved in all cases with a low rate of major complications (3.2%).
- The 6-month restenosis rate was 1.6%, with higher rates for ostial lesions (2.9%).
- One-year primary and secondary patency rates were 92% and 98%, respectively; two-year rates were 79% and 92%. Seventy-six percent of patients experienced blood pressure benefit, but renal function did not improve.
Conclusions:
- Renal artery stenting is a safe and effective adjunct to PTRA for atherosclerotic RAS.
- Stent placement provides durable long-term patency and contributes to blood pressure control in hypertensive patients.
- While improving patency, renal artery stenting does not restore renal function in patients with established stenosis.
Purpose:
To evaluate the long-term results of stent placement in the renal arteries.
Patients And Methods:
From January 1990 to August 1994, 59 hypertensive patients underwent 64 stent placement procedures. Indications were residual stenosis after percutaneous transluminal renal angioplasty in 42 patients, restenosis in 20 patients, and acute dissection in two patients. Follow-up (mean, 14 months) was obtained in 54 patients. Six-month restenosis rates were based on results of arteriography, and even more long-term patency rates were based on duplex ultrasound.
Results:
Technical success was achieved in all patients. Major complications occurred in two patients. No minor or puncture-site complications were observed. The overall 6-month restenosis rate was 1.6% (2.9% for ostial lesions). Survival analysis with the Kaplan-Meier method showed primary and secondary patency rates of 92% +/- 3.6 and 98% +/- 1.9, respectively, at 1 year and 79% +/- 8.8 and 92% +/- 6.1, respectively, at 2 years. Seventy-six percent of hypertensive patients benefited from the procedure. However, renal function was not improved by stent placement.
Conclusion:
Stent placement in renal arteries is a useful adjunct to percutaneous transluminal angioplasty for atherosclerotic renal-artery stenoses.