Percutaneous renal artery stent implantation in the treatment of atherosclerotic renal artery stenosis

Abstract

We aimed to investigate the clinical curative effect of percutaneous renal artery stent implantation (PTRAS) in the treatment of atherosclerotic renal artery stenosis (ARAS), and to analyze the factors influencing the curative effect of PTRAS. A total of 230 patients with unilateral or bilateral renal artery stenosis were retrospectively analyzed. According to whether adverse cardiogenic or nephrogenic events occurred, 230 patients were divided into two groups to analyze the risk factors of adverse cardiogenic or nephrogenic events. The blood pressure of patients at each time-point after operation was decreased significantly compared with that before operation (P<0.01). The levels of serum creatinine (SCr) at 24 h and 36 months after PTRAS were slightly increased compared with that before operation (P>0.05). The estimated glomerular filtration rate (eGFR) at each time-point after operation was slightly decreased compared with that before operation, but the difference was not statistically significant (P>0.05). Renography showed that GFR on the side of stent implantation at 36 months after PTRAS had no significant change compared with that before operation (P>0.05), but GFR on the unaffected side without receiving PTRAS was significantly increased compared with that before operation (P=0.0014). During the 36-month follow-up, there were a total of 56 cases of adverse cardiogenic or nephrogenic events. Multivariate regression analysis results showed that adverse cardiogenic or nephrogenic events after PTRAS were obviously associated with age (≥65 years old), Charlson comorbidity index (CCI) score (≥2 points), diabetes mellitus, stroke and congestive heart failure (CHF) (P<0.05). In conclusion, PTRAS can effectively control the blood pressure and reduce the types of antihypertensive drugs used by patients with ARAS, but it has no definitely protective effect on renal function. Age (≥65 years old), CCI score (≥2 points), diabetes mellitus, stroke and CHF are risk factors leading to adverse cardiogenic or nephrogenic events after PTRAS.

The Maintained Glycemic Target Goal and Renal Function Are Associated with Cardiovascular and Renal Outcomes in Diabetic Patients Following Stent-Supported Angioplasty for Renovascular Atherosclerotic Disease

“…In our study, MACCE-RRT was observed in 49.5% of diabetic patients at follow-up, compared to general population where adverse outcomes were reported in 30% to 75% of patients undergoing PTA for ARAS [19,22,23,26]. However, meta-analysis of randomized and non-randomized studies showed the effect size of 0.55 to 2.35 for all-cause death and cardiovascular mortality, with no statistically significant differences between PTA and medical therapy alone [27].…”

“…Furthermore, results of the clinical series showed that revascularization of the stenotic lesion compared with medical therapy may be potentially associated with renal and cardiovascular prognosis improvement [10,21,22]. Thus, data gathered in this field strongly suggest individualized and personalized attitude as they are mostly ambiguous [23][24][25].…”

“…Hu et al indicated in a group of 230 patients followed for 36 months, that T2DM (OR, 2.15; 95%CI 1.1 to 4.1) is independently associated with risk of renal and cardiovascular adverse events after renal artery stent implantation for ARAS, together with age ≥ 65 years old, Charlson comorbidity index score of ≥2 points, previous stroke and congestive heart failure [23]. Similarly, higher all-cause mortality rates were demonstrated among 138 patients with diabetes (HR 1.42; 95% CI, 1.09 to 1.86) out of the total 398 patients enrolled in Takahashi et al study [7].…”

“…Importantly, in observational studies, most of patients, including the diabetic, have a beneficial blood BP response after intervention on ARAS [19,23,26,31,32,40]. In fact, significant BP reduction following PTA for ARAS is commonly reported from clinical series [19,23,26,31,32,40,41].…”

Development and Validation of a Prognostic Nomogram for Prognosis in Patients With Renal Artery Stenosis

“…AUCi was one of the independent risk factors for RFD during 1 year of follow-up. Therefore, renal cortical blood perfusion is a useful supplement for clinicians to evaluate the degree of renal ischemia, judge the prognosis, and guide the treatment of RAS revascularization ( 18 ).…”