Stenting in Renal Artery StenosisBackground Renal artery stenosis RAS is a major cause of renovascular hypertension and reduced renal function due to ischemic atrophy of kidney. There are several methods to treat the RAS, including are surgery, percutaneous transluminal renal angioplasty, and medical treatment. The purpose of this study is to evaluate the usefulness, safety, and efficacy of percutaneous transluminal stent deployment in RAS.Method From January 1995 to July 1996, 17 patients underwent renal stent implantation due to renal artery stenosis 11 male, 6 female . The mean age was 49 years old, one patient had both renal artery stenosis and total lesions were 18. The causes of renal artery stenosis were atherosclerosis in 12, fibromuscular dysplasia in 2, Takayasu s disease in 2, and autoimmune disease Bechet's in one case. Renal artery stenting was performed via femoral artery in 12 lesions and brachial artery in 6 lesions. Follow up was performed by renogram, renal angiogram, and clinical examination.Result The degree of renal artery stenosis was 83% 70 95% . The lesion sites were 12 ostial and 6 non-ostial lesions. The used renal stents were Palmaz-biliary stent in 17 lesions and Micro-II stent in one lesions. All stents were implanted successfully and there was no residual stenosis in all patients except one case showed 20% residual stenosis due to huge renal artery size. The transstenotic pressure gradients after renal artery stenting was decreased markedly from 74mmHg to 2mmHg. There was no serious complications such as a death, emergency surgery, or nephrectomy. There were two minor complications which were one case of pyelonephritis and one case of inguinal hematoma. After stenting, blood pressure was decreased partially in 13 patients and completely in 2 cases.Conclusion Renal artery stenting appears to be safe and feasible and the alternative treatment modality to surgery for renal artery stenosis.KEY WORDS Renal artery stenosis·Renal stent. 서 론

Background and Objectives Carotid artery stenting has evolved as a potential alternative to carotid endarterectomy in patients pts with significant carotid artery stenosis. We evaluated the feasibility and long-term outcome of carotid artery stenting in selected pts at high surgical risk. Materials and Methods Between May, 1996 and September 1998 we performed carotid artery stenting at 35 lesions in 25 pts. There were 23 males and 2 females. Mean age was 63.2 6.6 range 54 77 . Eight four percent 21/25 of the pts had significant coronary artery disease. Sixty four percent 16/25 of the pts had significant peripheral artery lesions. Sixty percent 15/25 of the pts had neurologic symptoms or non-disabling stroke. We used Wallstent in 32 lesions and Palmaz stent in 3 lesions. Carotid stenting was undertaken in 33 internal carotid, 1 common carotid and 1 external carotid lesions. Bilateral carotid stenting was undertaken in forty percent 10/25 of the pts. Results Carotid stenting was successful in all lesions. One patient died due to massive cerebral hemorrhage 3 days after carotid stenting, who had und-erwent stenting as a rescue procedure for failed endarterectomy. One major stroke developed during procedure with partial recovery. For the combined endpoint of strokes and death within 30 days of procedure, the incidence was 8 and 5.7 in terms of pts and procedures, respectively. On follow-up 12 7 months , we found neither neurologic complications nor death. Angiographic and/or duplex sonography which were performed at 5.5 month in all 18 eligible pts with 24 lesions revealed no evidence of stent deformity or restenosis 50 of diameter stenosis . Mean angiographic stenosis was 20 on follow-up angiography. Conclusion Carotid artery stenting can be performed with high success and low complication rate in pts with significant carotid artery stenosis especially at high surgical risk. Follow-up clinical outcome of average 12 month was good with low restenosis rate.

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Background Coronary stenting is known to reduce the rates of restenosis in focal lesions, but the efficacy of stents for long lesions have not been thoroughly defined. To evaluate the immediate and follow-up results of three different types of stents in lesions longer than 20mm, consecutive series of patients pts were reviewed. Methods Between February 1996 and January 1997, 123 patients male 68.3%, mean age 57 10 years) with a total of 130 lesions underwent long stent stenting. Excluding multiple stents and unplanned use for acute closure fifty-three pts 56 lesions were treated with the Microstent M-30 pts 31 lesions received the Less Shortening Wallstent WA and 40 pts 43 lesions were treated by the Gianturco-Roubin stent GR-. Results With the clinical success defined as 30% residual stenosis without death, CABG, Q-wave MI was achieved in 93% with the M , 94% with the WA and 95% with the GR-. Stent thrombosis occurred 0% in M-, 1.5% in WA and 2.3% in GR-. Clinical success and stent thrombosis rates were not different between the three types of stents. Follow-up FU quantitative angiography was obtained from 34 pts 64% in M-, 25 lesions 83% in WA and 26 pts 65% in GR-after 6 months. Restenosis rate defined as 50% diameter stenosis at FU was 26% in M-, 32% in WA and 38% in GRthere was no significant difference between the three stents. Target lesion revascularization TLR defined as CABG or target lesion PTCA at FU was 17.6% in M-, 12% in WA and 23.1% in GR-. Restenosis rate correlated closely with lesion length p-value 0.03, Odds ratio 1.096 and small post-stent luminal diameter p-value 0.002, Odds ratio 0.063 in a mu-ltivariable analysis. Conclusion Coronary stenting for long lesions can be safely performed with acceptable complication rates using any of the three types of stents. Restenosis and late outcome was not related to type of stent. Korean Circulation J 1998 ; 28 4 : 553-559