Eficácia clínica da revascularização renal percutânea com implante de stent em pacientes com doença renovascular aterosclerótica

Abstract

Objective: To evaluate the clinical efficacy of percutaneous renal revascularization with stenting to control hypertension and preserve/restore renal function in patients with atherosclerotic renovascular disease. Methods:From May/1999 to October/2003, 46 patients with atherosclerotic renal artery stenosis (ARAS) underwent revascularization with stenting. The indication for the procedure was hypertension control and/or renal function preservation/ restoration. Clinical characteristics: age range: 33-84 years (median = 58.5 ±10.7), males: 26 (56.5%), 4 (10%) patients with dia betes mellitus, 21 (46%) patients with coronary artery disease, creatinine <2.0mg/dl: 39 (64%), 6 patients (14%) with congestive heart failure, 20 (43%) patients with ostial stenosis and 15 (33%) patients with bilateral stenosis. Hypertension control was evaluated by the number of drugs used before the procedure and at follow-up (FU) and by blood pressure (BP) measurement. Results:The minimum follow-up was 7 months (range of 7-52, median: 23, mean: 24.2 ± 15.2). There were no major complications. No patient experience any cardiovascular event. There was only one non-cadiac death (2%) and one technical failure in the treatment(2%). There was no serious complication in the procedure. None of the patients presented cardiovascular events. The renal function improved or stabilized in 32 patients (82%) and worsened in 4 (10%). The BP control improved in 19/44 (43,8%) patients and worsened / stabilized in 6 patients (14%). Conclusion:Angioplasty with renal artery stenting for ARAS showed to be an effective treatment strategy to restore and preserve renal function and to control blood pressure. Atherosclerotic renal artery stenosis (ARAS) is one of the causes of systemic hypertension (SH) and renal failure 1-3 . Its real prevalence is unknown, but it is estimated that up to 5% of hypertensive patients have ARAS as the etiology of SH. The clinical relevance of ARAS has increased due to global longer life expectancy and higher prevalence of SH and diabetes mellitus 4,5 . In this group of patients, the simultaneous occurrence of atherosclerosis in different sites is very common 6 . A study carried out by Baboolal, in 1998, described the mortality, the rate of renal function decrease and the incidence of end-stage renal disease in 51 patients with bilateral ARAS, who were followed up during a mean of 52 months 7 . Such patients did not undergo percutaneous or surgical intervention. The evaluation of renal function showed impairment at the time of angiography and a variable, non-uniform decline during the observation period. After 5 years, there was a progressive increase in the incidence of end-stage renal disease (ESRD). Six out of 51 patients who were evaluated with angiography presented ESRD. The therapeutic resources for ARAS are the control of SH and other risk factors for cardiovascular events and renal revascularization, which can be achieved by surgery or angioplasty (with or without stent placement).Percutaneous revascularization techniques are...

Prevalence of Renal Artery Stenosis in Patients Undergoing Coronary Angiography

“…Angioplasty of ARAS with renal artery stenting is a beneficial treatment strategy to restore and preserve renal function and to control blood pressure. 2 The mortality rate in patients with cardiovascular disease increases in the presence of RAS. The occurrence of RAS ranges from 3-30% in CAD patients with varying severity who underwent Coronary Angiography (CAG).…”