Angiographic and Intravascular Ultrasound Assessment of Immediate and 9-Month Efficacy of Percutaneous Transluminal Renal Artery Balloon Angioplasty with Subsequent Brachytherapy in Patients with Renovascular Hypertension

Abstract

Background/Aim: Scarce data exist concerning the long-term effect of renal balloon angioplasty (PTRA) enhanced by intravascular γ-brachytherapy (IVBT) in patients with renovascular hypertension. The aim of this randomized study was to evaluate long-term outcome after PTRA with IVBT in patients with renal artery stenosis. Patients and Methods: 71 patients with renovascular hypertension were randomized into group I (PTRA + IVBT) or group II (PTRA). 9 patients who required stent implantation were excluded. Both baseline and 9-month follow-up quantitative computerized angiography and intravascular ultrasound (IVUS) analysis were performed to assess restenosis. During the 9-month follow-up, 3 patients died – 2 from group I and 1 from group II. Results: The restenosis rate was 16.1% in group I and 32.1% in group II. The 9-month lumen loss in angiography was 1.2 ± 0.7 and 1.7 ± 0.7 mm (p = 0.004) and the area loss (IVUS) was 6.5 ± 4.8 and 10.1 ± 5.6 mm² in groups I and II, respectively (p = 0.01). eGFR increased both in group I (from 75 ± 22 to 84 ± 31 ml/min/1.73 m²; p < 0.001) and in group II (from 74 ± 23 to 77 ± 23 ml/min/1.73 m²; p = 0.04). Only the diastolic blood pressure in group I decreased significantly (65 ± 17 and 77 ± 18 mm Hg; p = 0.048). The rate of blood pressure normalization was low in both groups (6.1 and 6.9%). Conclusions: IVBT after PTRA with a self-centering source is a safe and effective method for prevention of restenosis in patients with renovascular hypertension.

SNP rs198389 (T‑381 C) polymorphism in the B‑type natriuretic peptide gene promoter in patients with atherosclerotic renovascular hypertension

“…8,9 One of the approaches to improving long-term effectiveness of the procedures can be renal artery angioplasty optimization by using intravascular ultrasonography. 10 Recently, the increased serum BNP level in patients with renovascular hypertension unrelated to heart failure and acute coronary syndromes has received considerable attention. It has been proven that an initially increased serum BNP level decreases after successful angioplasty procedure.…”

Diagnosis and treatment of renal artery stenosis

“…another trial compared angioplasty alone with angioplasty plus intravascular brachytherapy. 50 luminal loss and incidence of restenosis at 9 months were lower in the group that received brachytherapy, but blood pressure and glomerular filtra tion rate did not differ between the two groups. the dissociation of improved renal artery patency and clinical outcome in patients with atherosclerotic ras illustrates the effect of irreversible injury in the poststenotic kidney.…”

Non-Coronary Vessel Exploration Under Intravascular Ultrasound: Principles and Applicability

“…The volumetric approach using 3-D border-detection techniques is currently applied in serial IVUS studies examining atherosclerotic disease progression or regression, allowing the assessment of plaque burden in an entire vessel segment through fast analysis of large image sequences. New interventional approaches also use a volumetric IVUS imaging approach to provide new mechanistic insights, such as innovative techniques aimed at the prevention and treatment of in-stent restenosis correlated with histomorphometry measurements (Mehran et al, 1998;Murata et al, 2002); approaches in understanding the effects of radiation therapy and the arterial remodeling on a stented segment (brachytherapy) (Lekston et al, 2008;Weichert et al, 2003;Zimarino et al, 2002;Zimmermann et al, 2005); or using drug-eluting stents on the neointimal hyperplasia development (Jensen et al, 2008;Min et al, 2007;Sano et al, 2006).…”