Short- and mid-term results of balloon angioplasty for renal artery fibromuscular dysplasia

Abstract

This study aimed to evaluate short- and mid-term outcomes of percutaneous transluminal renal artery angioplasty (PTRA) in patients with symptomatic renal artery stenosis caused by renal artery fibromuscular dysplasia (RAFMD). Retrospective analysis of 22 patients with RAFMD who were performed PTRA between 2006 and 2012. These patients underwent PTRA due to poorly controlled hypertension. Pre- and post-PTRA blood pressure (BP) measurements and renal function were evaluated. Freedom from events (restenosis, repeat intervention, renal failure, and recurrent hypertension) was investigated using life table analysis. Twenty-two patients (54.5% women, mean age 39.2 years) with 24 renal arteries underwent PTRA. The technical success rate was 100%. The mean systolic BP decreased from 155.9 ± 14.7 to 138.3 ± 9.41 mmHg (P = 0.00004), and the mean diastolic BP decreased from 99.0 ± 11.5 to 88.0 ± 7.19 mmHg (P = 0.0043). Rates of freedom from recurrent or worsening hypertension, defined by >140 mmHg systolic BP and >90 mmHg diastolic BP, were 89.4, 89.4, 81.3, and 71.1% at 1, 2, 3, and 4 years, respectively. Restenosis-free rates were 90.0, 83.6, 73.4, and 61.9%, respectively. No patient underwent repeat intervention and renal failure. PTRA is a durable modality for treating RAFMD with favorable short- and mid-term clinical outcomes.

Percutaneous transluminal angioplasty with selective stenting for the treatment of renal artery stenosis caused by fibromuscular dysplasia: 18 years' experience from the China Center for Cardiovascular Disease

“…Restenosis after PTA is a key factor affecting blood pressure outcomes. According to the literature, the incidence of restenosis is 15–35% . However, studies indicate that most patients benefit from secondary PTA treatment and this study showed similar results.…”

“…According to the literature, the incidence of restenosis is 15-35%. 15,17,18 However, studies indicate that most patients benefit from secondary PTA treatment and this study showed similar results. Previous literature reported renal artery in-stent stenosis is 10% in patients with atherosclerotic RAS, 19 but the restenosis rate of selective stent is very low in this study.…”

Renal Fibromuscular Dysplasia: A Not So Common Entity of Secondary Hypertension

“…The only data available are derived from observational studies showing clinical benefit with interventional therapy. Periprocedural adverse effects that often complicate interventions in ARAS are rare in FMD, thus making patients with FMD more eligible for intervention . In cases where FMD involves distal or smaller branches, percutaneous intervention becomes difficult and restenosis is more common …”

“…Even though there are no studies comparing endarterectomy with percutaneous interventions, and given that FMD is not focal but diffuse and sometimes bilateral, it seems that endarterectomy is not the first‐line therapy for these patients. Furthermore, since percutaneous interventions are quite effective not only in BP control but also in preserving renal function, endarterectomy should be reserved solely for patients who cannot be treated otherwise …”

“…Several studies on renal artery intervention are summarized in Table III, seven of which included only patients with ARAS [28][29][30][31][32][33][34] and three of which included patients with FMD. [35][36][37] Observational studies in ARAS have shown net clinical benefit with interventional therapy in terms of BP control and renal function preservation. Conversely, in randomized controlled trials, medical therapy indicated a similar effect in lowering BP compared with interventional therapy.…”