Drug-eluting stents in renal artery stenosis

Abstract

Because of higher acute and long-term success rates compared with balloon angioplasty alone, percutaneous stent implantation has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis. Restenosis rates after successful renal stent placement vary from 6 up to 40%, depending on the definition of restenosis, the diameter of the treated vessel segment and comorbidities. The safety and efficacy of drug-eluting stents for the treatment of renal-artery stenosis is poorly defined. The recently published GREAT study is the only prospective study, comparing bare-metal and sirolimus-coated low profile stent systems in renal artery stenosis, showing a relative risk reduction of angiographic binary in-stent restenosis by 50%. This is an opinion paper on indications, current treatment options and restenosis rates following renal artery stenting and the potential use of drug-eluting stents for this indication.

Endovascular brachytherapy for renal artery in-stent restenosis

“…Further, the drug-eluting stent is more costly than the bare-metal stent and likely will need long-term antiplatelet therapy with aspirin and clopidogrel. 31 Concerns have also been raised about the durability of the thinner coronary stents in the renal arteries that may lack the radial strength needed to overcome the increased potential for elastic recoil of aorto-ostial renal artery stenosis. 22 The current use of coronary drug-eluting stents in renal arteries is also limited by the 4-mm maximum size of available stents, although the directions for use for some of these stents (ION and Promus) state that they can be dilated to 5.75 mm.…”

Use of Drug-Eluting Stent with Provisional T-Stenting Technique in the Treatment of Renal Artery Bifurcation Stenosis; Long-term Angiographic Follow-up

“…Bifurcation lesions are frequent in coronary arteries, and treatment with a stent is common even though it is difficult (7). Studies from the bare-metal stent (BMS) era consistently demonstrated that the one-stent approach was superior to the two-stent approach; this view remains controversial in the DES era (8). Although two-stent strategy has not been proven to be superior in the treatment of coronary arteries, this might not be true in renal artery stenosis.…”

Medikamentöse oder instrumentelle Therapie der Nierenarterienstenose?

“…Eine Bedeutung im klinischen Alltag haben DES in der NAST-Therapie bisher nicht erreicht [29]. Umfangreichere Erfahrung gibt es für DES bei der InStent-Restenose [24].…”