Randomised Comparison of Percutaneous Angioplasty vs Continued Medical Therapy for Hypertensive Patients With Atheromatous Renal Artery Stenosis

Webster, J; Marshall, Freda; Abdalla, Marwah; Dominiczak, A. F.; Edwards, R. A.; Isles, Christopher; Loose, H; Main, John; Padfield, P L; Russell, IT; Walker, Betina Reseck; Watson, Michael A.; Wilkinson, Robert H.

doi:10.1016/s0022-5347(05)68893-3

Cited by 54 publications

(103 citation statements)

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“…Bekannt ist, dass das ereignisfreie 6-Jahres-Überleben in diesem Patientenkollektiv lediglich 53% beträgt und dass das Risiko für kardiovaskuläre Ereignisse mit dem Schweregrad der NAST korreliert [49]. Vice versa konnte bei Patienten im Alter > 70 Jahre und bestehender Herzinsuffizienz NYHA (New York Heart Association) II-IV in 34% der Fälle eine NAST gefunden werden [33].…”

Section: Klinikunclassified

“…Betrachtet man das interventionelle Vorgehen zunächst im Hinblick auf die bestehende arterielle Hypertonie, kann zurzeit auf die Daten von drei randomisierten Studien zurückgegriffen werden [37,46,49]. In allen drei Untersuchungen hat die Intervention bei unilateraler NAST zu keiner signifikant überlegenen Senkung des Blutdrucks gegenüber der antihypertensiven Therapie geführt.…”

Section: Interventionelle Therapieunclassified

“…In allen drei Untersuchungen hat die Intervention bei unilateraler NAST zu keiner signifikant überlegenen Senkung des Blutdrucks gegenüber der antihypertensiven Therapie geführt. Lediglich in der Studie von Webster et al wurde nach Intervention bilateraler Stenosierungen ein signifikanter Blutdruckabfall beobachtet [49]. Van Jaarsveld et al berichteten von einer signifikanten Reduktion der Anzahl an Antihypertensiva in der Interventionsgruppe [46].…”

Section: Interventionelle Therapieunclassified

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Die Nierenarterienstenose

et al. 2009

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Renal artery stenosis (RAS) is both a common and progressive disease and its prevalence in patients > 65 years is 6.8%. In patients with known or suspected atherosclerosis undergoing coronary angiography, a frequency of even 11-23% is reported in the literature. Despite this high prevalence, there is an ongoing discussion about the indications for revascularization and it is currently unclear, whether renal artery revascularization reduces adverse cardiovascular and renal events. Nevertheless, the number of interventions for RAS is rising steadily, although up to 40% of patients do not profit from this intervention. This fact underlines the necessity of a thorough diagnostic work-up before intervention, integrating morphological and functional tests. For morphological evaluation, multislice computed tomography, magnetic resonance tomography or digital subtraction angiography can be done. In experienced centers, Doppler ultrasound can serve as an excellent functional tool, to assess the physiological relevance of an RAS, but also invasive measurements of pressure and flow provide valuable information about the significance of stenoses; however, these methods will have to be assessed with respect to their value to predict long-term outcome. Although percutaneous intervention of RAS is associated with a substantially lower risk of major adverse events as compared to surgery, by using contrast media this procedure holds the risk of deterioration of renal function and of a small number of procedure-dependent complications as well. Thus, a careful consideration of pros and cons of this procedure is mandatory.

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Section: Klinikunclassified

Section: Interventionelle Therapieunclassified

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Die Nierenarterienstenose

et al. 2009

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“…However, curing renovascular hypertension after endovascular treatment is rare and improved hypertension control with fewer medications is a more realistic goal [1,2,11,12]. Currently, three randomized controlled trials on the effects of balloon angioplasty compared to medical treatment of RAS in hypertensive patients have been published [14,28,29]. These data including 210 patients have been recently reviewed in a Cochrane Systematic Review [30].…”

Section: Hypertensionmentioning

confidence: 99%

Treating Renal Artery Stenosis

Schillinger

Minar

Ahmadi

2004

Herz

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Renal artery stenosis (RAS) leading to hypertension or ischemic nephropathy can be treated by endovascular revascularization using balloon angioplasty or stent implantation. Although high technical success rates > 95%, relatively low frequencies of complications and good long-term patency can be achieved, the indications for interventional treatment are a matter of ongoing debate. Curing hypertension by means of angioplasty rarely occurs, although the number of antihypertensive medication usually can be reduced after successful treatment. Targeting ischemic nephropathy, revascularization can stabilize or at least slow the decline of renal function. Nevertheless, angioplasty also bears the risk of inducing renal deterioration. Careful patient selection remains the most crucial point in renal interventions, however, current data are insufficient to give final recommendations on this issue. The present review focuses on the potential beneficial effects of renal artery PTA and stenting in patients with RAS.

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“…In der prospektiv randomisierten englisch-schottischen Studie von Webster et al [88], in der ebenfalls Intervention und medikamentöse Therapie verglichen wurden, zeigten sich nach 6 Monaten keine Unterschiede bezüglich Blutdruck und Nierenfunktion. In der Interventionsgruppe wurde eine signifikante Reduktion der Anzahl der Antihypertensiva von 2,8 auf 2,3 nach 6 Monaten erreicht.…”

Section: Tabelle 4 Ergebnisse Aller Prospektiv Randomisierter Studieunclassified