Different Outcomes of Atherosclerotic Renal Artery Stenosis Managed with Stenting: Results from a Cohort Study

Mannarino, Antonio; Spatoliatore, Giuseppe; Caselli, Gian Marco; Toti, G. L.; Becherelli, P

doi:10.3109/0886022x.2011.646807

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…As reported before from our institution, 13,14 studies in favor of renal revascularization and others 3,15,16 indicate that renal stenting may play a role in patients with rapid deterioration of their renal functions or acute worsening of eGFR with disease affecting more than 75% of overall renal mass. 17,18 Stabilization of renal function has been another important finding in multiple studies. 15,19,20 Clinicians should be aware that some reports suggest benefit of RASt in selected groups of patients 21–28 ; therefore, the above mentioned randomized trials with conclusions not supporting RASt should be examined in light of their obvious flaws 4 as potential candidates who may have benefitted from RASt were excluded from enrollment.…”

Section: Efficacy Of Renal Artery Interventionsmentioning

confidence: 99%

Issues related to renal artery angioplasty and stenting

et al. 2017

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Renal artery stenosis may play a significant role in the pathogenesis of secondary hypertension, renal dysfunction, and flash pulmonary edema. Currently correction of renal arterial inflow stenosis is reserved for resistant hypertension patients who have failed maximal medical therapy, have worsening renal function and/or unexplained proximal congestive failure. With the recent advances in minimally invasive percutaneous stent placement techniques, open surgical revascularization has been largely replaced by renal artery stenting. The potential benefit of revascularization seemed intuitive; however, the initial enthusiasm and rise in the number of percutaneous interventions have been tempered by many subsequent negative randomized clinical trials that failed to prove the proposed benefits of the percutaneous intervention. The negative randomized trial results have fallen under scrutiny due to trial design concerns and inconsistent outcomes of these studies compared to pivotal trials undertaken under US Food and Drug Administration scrutiny. Treatment of atherosclerotic renal artery occlusive disease has become one of the most debatable topics in the field of vascular disease. The results from recent randomized clinical trials of renal artery stenting have basically limited the utilization of the procedure in many centers, but not every clinical scenario was covered in those trials. There are potential areas for improvement focusing mainly on procedural details and patient selection with respect to catheter based treatment of atherosclerotic renal artery stenosis. We believe, limiting patient selection, enrollment criteria and outcomes measured functioned to reduce the benefit of renal artery stenosis stenting by not enrolling patients likely to benefit. Future studies incorporating potential procedural improvements and that include patients more likely to benefit from renal stenting than were included in ASTRAL and CORAL are needed to more carefully examine specific patient subgroups so that "the baby is not thrown out with the bath water." We also discuss several other concerns related to renal artery stenting which include diagnostic, procedure, indication, and reimbursement issues.

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Section: Efficacy Of Renal Artery Interventionsmentioning

confidence: 99%

Issues related to renal artery angioplasty and stenting

et al. 2017

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“…Nel 2012, abbiamo pubblicato la nostra esperienza condotta su 30 pazienti con ARAS avviati a stenting renale (12). I pazienti presentavano una riduzione lieve-moderata della funzione renale (CKD stadi 3-4) e ipertensione arteriosa in trattamento con 3 farmaci; la durata del follow up è stata di 33 mesi.…”

Section: Stenosi Aterosclerotica Dell'arteria Renale: Esiste Ancora Spazio Per La Rivascolarizzazione Dell'arteria Renale?unclassified

Stenosi aterosclerotica dell'arteria renale: esiste ancora spazio per la rivascolarizzazione dell'arteria renale?

Mannarino

2015

G Clin Nefrol Dial

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Magnetization Transfer Imaging Predicts Porcine Kidney Recovery After Revascularization of Renal Artery Stenosis

et al. 2020

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Objectives Magnetization transfer imaging is a novel noninvasive tool for the detection of kidney fibrosis, but its association with kidney function and hemodynamics is unclear. Renovascular disease (RVD) associated with metabolic derangements elicits renal fibrosis and is often unresponsive to percutaneous transluminal angioplasty (PTRA), but tools to predict therapeutic success are unavailable. We hypothesized that magnetization transfer imaging predicts kidney recovery after PTRA in swine with unilateral RVD. Materials and Methods Stenotic kidney (STK) and contralateral kidney magnetization transfer ratios (MTRs; M t/M 0) were measured at 3.0-T magnetic resonance imaging, at offset frequencies of 600 and 1000 Hz, before and 1 month post-PTRA in 7 RVD pigs. Stenotic kidney MTR was correlated to renal perfusion, renal blood flow (RBF), and glomerular filtration rate (GFR), determined using multidetector computed tomography and with ex vivo renal fibrosis (trichrome staining). Untreated RVD (n = 6) and normal pigs (n = 7) served as controls. Results Renovascular disease induced hypertension and renal dysfunction. Blood pressure and renal perfusion were unchanged post-PTRA, but GFR and RBF increased. Baseline cortical STK-MTR predicted post-PTRA renal perfusion and RBF, and MTR changes associated inversely with changes in perfusion and normalized GFR. Stenotic kidney MTR at 600 Hz showed closer association with renal parameters, but both frequencies predicted post-PTRA cortical fibrosis. Conclusions Renal STK-MTR, particularly at 600 Hz offset, is sensitive to hemodynamic changes after PTRA in swine RVD and capable of noninvasively predicting post-PTRA kidney perfusion, RBF, and fibrosis. Therefore, STK-MTR may be a valuable tool to predict renal hemodynamic and functional recovery, as well as residual kidney fibrosis after revascularization in RVD.

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Different Outcomes of Atherosclerotic Renal Artery Stenosis Managed with Stenting: Results from a Cohort Study

Abstract: The predictable benefit from renal stenting may be most likely in patients presenting with a rapid decline of GFR associated with renal artery stenosis affecting the whole renal mass that is both kidneys or single functioning kidney.

Cited by 5 publications

References 25 publications

Issues related to renal artery angioplasty and stenting

Issues related to renal artery angioplasty and stenting

Stenosi aterosclerotica dell'arteria renale: esiste ancora spazio per la rivascolarizzazione dell'arteria renale?

Magnetization Transfer Imaging Predicts Porcine Kidney Recovery After Revascularization of Renal Artery Stenosis

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