Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis

Abstract

Background-Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. Methods and Results-Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for Ն6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166Ϯ26 to 148Ϯ22 mm Hg and from 86Ϯ14 to 80Ϯ11 mm Hg, respectively; PϽ0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74Ϯ4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92Ϯ4%) baseline renal function, fair (74Ϯ7%) in those with mildly impaired renal function, and poor (52Ϯ7%) in patients with elevated baseline creatinine levels (Ն2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. Conclusions-Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival. (Circulation. 1998;98:642-647.)

Atherosclerotic renal artery stenosis: is it worth diagnosing?

“…Stenting cured hypertension in 0-16%, with improvement (mean reduction of half of one hypotensive drug) in around half of patients. 19,25,26 Even the modest improvement in blood pressure may be overestimated in these uncontrolled studies as recorded blood pressure in patients with RVH spontaneously falls with follow up. 28 Three prospective randomised controlled trials comparing PTRA +/− stenting have recently reported.…”

“…The probability of survival at 3 years being 92% with normal renal function, 74% with mild and 52% in those with more severe renal failure. 19 Survival on dialysis is worse than for any other patient group. At 2 years nearly half will have died and at 5 years only 12% will be alive.…”

“…Several series report initial technical success of over 90% with less than 20% restenosis over 2 years. 5,19,[24][25][26] A clear benefit of revascularisation over medical management of atheromatous renovascular hypertension has not been demonstrated. Ramsay reviewed 10 uncontrolled series of PTRA for atheromatous RVH.…”

Intravascular ultrasound‐guided cutting balloon angioplasty for renal artery stent restenosis

“…[1][2][3][4][5][6][7][8] While restenosis occurs in > 50% of patients treated with percutaneous transluminal renal angioplasty, 9-11 restenosis rates of renal artery stents are only 10-25%. [2][3][4][5][6] As expected, the risk of renal artery stent restenosis is related to stent diameter, with larger stent diameters having lower rates of restenosis. Lederman et al demonstrated that renal stents with > 4.5 mm diameter had a 12% restenosis rate while renal stents of < 4.5 mm in diameter had restenosis rate of 21%.…”

“…Renal artery stenting is the procedure of choice for treating atherosclerotic renal artery stenosis. [1][2][3][4][5][6][7][8] However, long-term benefits of renal artery stenting may be blunted by the development of stent restenosis, and the treatment of this condition is not well established, with limited therapeutic options. We present a case report of intravascular ultrasound-guided cutting balloon angioplasty (CBA) as a novel technique for the treatment of renal artery stent restenosis.…”