Long-term outcomes and determinants of stenosis recurrence after renal artery angioplasty in hypertensive patients with renovascular disease

Abstract

Introduction: Restenosis (RS) following percutaneous angioplasty (PTA) of renal artery stenosis (RAS) might have an unfavourable impact on renal function and blood pressure (BP) outcomes. Aim: To evaluate the prevalence and predictors of RS in patients treated with PTA for RAS, and the relationship between BP and renal function (RF) changes with RS. Material and methods: We analysed freedom from RS in 210 patients (age 64.6 ±12.8 years; range: 20-85), who underwent 248 successful stent-assisted PTAs in RAS. The change in levels of serum creatinine (SCC), estimated glomerular filtration rate (eGFR), systolic/diastolic BPs (SBP/DBP) were analysed prior to PTA, at 6-, 12-month, and final follow-up visits, and whenever RS was diagnosed. Results: RS was identified in 30 (14.3%) patients, and there were 36 (14.5%) lesions. The Kaplan-Meier RS-free survival curves in fibromuscular dysplasia, atherosclerosis, and vasculitis at 1 and 7 years were: 100% and 100%; 95.6 and 83.9%; and 71.4 and 39.7%, respectively. Patients with RS, as compared to RS-free patients, presented with less pronounced changes in respect with:

Case Report: Renal artery stenosis in children: ultrasound as a decisive diagnostic and therapy-accompanying technique!

“…Secondary damages due to resolved primary cause of arterial hypertension were prevented. Follow-up evaluation due to a recurrence rate of 20% is essential (6,7).…”

Preoperative clinical and renal ultrasonography variables associated with improved systolic and diastolic blood pressure reduction after renal artery stenting

“…Although, medical treatment is a first line management in patients with renovascular hypertension [4], recent population-based data show that blood lowering therapy is insufficient in about 30% of hypertensive patients leading to masked uncontrolled blood pressure elevations [7]. This blood pressure instability is most frequent in patients with cardiovascular comorbidities, and those who require multiple antihypertensive medications [7,8].…”

“…Although, systolic (SBP) and diastolic blood pressure (DBP) lowering following PTA for ARAS is associated with better outcomes, the effect of PTA on blood pressure response is difficult to predict [9,10]. For example randomized trials demonstrate mild or no advantage of PTA plus best medical therapy (BMT) over BMT alone in regard to blood pressure or renal function improvement in all-comers with ARAS [6,7,8,12]. On the other hand, observational studies reported potential advantage of PTA of ARAS in terms of cardiovascular death (CVD) and all-cause mortality risk decrease, blood pressure lowering or even hypertension cure [13,14,15].…”