Stenting of a renal artery stenosis achieves better relief of the obstructive lesion than balloon angioplasty

Abstract

A balloon-expandable (Palmaz-Schatz) stainless steel stent was utilized following balloon angioplasty (PTRA) to determine if the obstructive lesion, using quantitative methods (automated measuring the diameter stenosis, and transstenotic peak systolic and mean pressure gradients), was significantly further reduced or abolished. Hemodynamic transstenotic gradient and stenoses measurements were made during 21 renal artery stenting procedures; prior and following PTRA, and subsequent to stent deployment. The stent sizes placed in the renal arteries were 5 mm (19%), 6 mm (67%), and 7 mm (14%). The results were as follows: [table: see text] The balloon-expandable (Palmaz-Schatz) stent significantly further reduced, and in fact effectively abolished, the obstructive renal artery lesion in comparison to balloon angioplasty (PTRA). The stent's effectiveness with regard lesion recurrence, maintenance, and preservation of renal function; cure or improved management of hypertension; and survival will be determined by careful clinic follow-up.

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

“…Renal artery stent revascularization procedural results have been demonstrated to be superior to balloon angioplasty, 20,31 as assessed by hemodynamic transstenotic pressure gradient measurements, complication rates, and restenosis rates. The data presented here define its long-term benefits as manifest by significant decreases in the systolic and diastolic blood pressures, more facile blood pressure control, and a reduction in the number of antihypertensive medications.…”

“…20,24 A paired comparison used, at each interval, the patient's follow-up value compared with the baseline value. The life table (actuarial) methodology was used to determine survival, and a Cox regression hazard model assessed the impact of selected variables on survival.…”

ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary

“…Stent placement has consistently proven superior to balloon angioplasty in the treatment of renal artery atherosclerotic lesions (207,208). For renal artery atherosclerotic lesions, the larger the poststent minimal lumen diameter, as measured by quantitative vascular angiography, the better the late stent patency (209).…”

Stenting of a renal artery bifurcation stenosis

“…In this context, immediate and long-term results can be optimized by stenting [6][7][8][9][10][11]. Occasionally, lesions may involve a side branch in the midartery segment.…”