Factors Associated with Outcomes of Percutaneous Transluminal Renal Angioplasty in Patients with Renal Artery Stenosis: A Retrospective Analysis of 50 Consecutive Cases

Abstract

Background The results of recent trials have brought some confusion to the treatment strategy for renal artery stenosis (RAS). To evaluate the applicability of percutaneous transluminal renal angioplasty (PTRA) for RAS, we extracted the factors that may affect the effectiveness of PTRA from cases experienced at a hypertension center. Methods and Results We retrospectively assessed the blood pressure (BP) lowering effects and renoprotective effects in 50 consecutive patients that had hemodynamically significant RAS and had undergone PTRA and stenting during 2001–2005. Subjects were diagnosed with atherosclerotic RAS (42), fibromuscular dysplasia (6), or Takayasu disease (2). After PTRA, BP significantly lowered from 152.3/80.3 mmHg to 132.6/73.2 mmHg (p < 0.05), but the estimated glomerular filtration rate (eGFR) did not change significantly. There were no factors associated with the BP lowering effects of PTRA. The baseline resistive index (RI) was negatively correlated with the change in eGFR (p < 0.05). After correction for age, sex, BMI, and the dose of contrast medium, the association of RI with change in eGFR remained significant. Conclusion In cases with hemodynamically significant RAS, PTRA lowered BP but was not effective in improving renal function. Higher baseline RI may be a factor for predicting poor clinical course of renal function after PTRA.

Ultra-Low-Dose Contrast Using Transluminal Renal Angioplasty: The ULTRA Study

“…CIN is a major complication of catheter interventions. The most effective method to prevent CIN is to reduce the amount of contrast medium; however, it is di cult to reduce the amount of contrast medium in normal angiography (12,15,16); the average volume of iodinated contrast medium used in the previous studies was approximately 100 mL. Some studies have proposed that carbon dioxide (CO 2 ) can be used as a safe and effective contrast medium, however, the recent CO 2 angiography registry reported a mortality rate of 2% (2/100) (18).…”

“…The most effective way to prevent CIN is to reduce the contrast medium volume; however, it is difficult to do so in normal angiography. 12,15,16 The average volume of iodinated contrast medium used in previous studies was approximately 100 mL. Some studies proposed that carbon dioxide (CO 2 ) can be a safe and effective contrast medium 17 ; however, it is often difficult to evaluate the abdominal area due to abdominal gas.…”

Endovascular Versus Medical Management of Atherosclerotic Renovascular Disease: Update and Emerging Concepts

“…71 As such, it may guide patients' selection to PTRA. In fact, high RRI (RRI >0.8) suggests advanced parenchymal fibrosis and increased aortic stiffness and has been associated to a lower response to PTRA in most 34,[72][73][74] though not all 75 studies. Finally, while patients with advanced nephropathy (proteinuria >1 g/d or long duration of renal replacement therapy, proteinuria, and prolonged hypertension) are unlikely to benefit from PTRA, 76,77 Murphy et al 78 demonstrated that patients with mild or absent albuminuria may benefit more from blood flow restoration, both in terms of event-free survival, overall survival, cardiovascularrelated death, and progressive renal insufficiency.…”