Stents in the Treatment of Renal Artery Stenosis: Long-term Follow-up

Henry, Michel; Amor, Max; Henry, Isabelle; Éthevenot, Gérard; Tzvetanov, Kiril; Courvoisier, André; Mentre, B; Chati, Zukaï

doi:10.1583/1074-6218(1999)006<0042:sittor>2.0.co;2

Cited by 114 publications

(25 citation statements)

References 26 publications

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“…The average restenosis rate, evaluated between 6 and 12 months after the procedure, was 16%. A second meta-analysis, comparing renal stent (733,735). In those series, the 5-year primary patency rates of renal stents were 79% and 84.5%, and the secondary patency rates were 92.4% and 98%.…”

Section: Catheter-based Interventionsmentioning

confidence: 99%

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

Hirsch

Haskal²,

Hertzer³

et al. 2006

Circulation

2,969

1,111

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Section: Catheter-based Interventionsmentioning

confidence: 99%

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

Hirsch

Haskal²,

Hertzer³

et al. 2006

Circulation

2,969

1,111

View full text Add to dashboard Cite

“…72 These excellent results were confirmed by Henry and associates, 73 who reported a cumulative primary patency rate of 78.8% and a secondary patency rate of 97.8% at 6 years (72 to 78 months) of follow-up.…”

Section: Restenosismentioning

confidence: 68%

“…37,71 More recent reports suggest that with optimal deployment techniques, restenosis rates of less than 15% can be achieved. 59,62,72,73 Renal artery restenosis after stent placement is related to both acute gain and late loss, similar to restenosis after coronary artery intervention. We performed quantitative angiography on a series of 100 consecutive patients and found that patients with patent renal arteries at 8-month follow-up had significantly larger postprocedure minimal lumen diameter (4.3Ϯ0.7 mm versus 4.9Ϯ0.9 mm; Pϭ0.025) and had significantly less late loss (1.3Ϯ0.9 mm versus 3.0Ϯ1.4 mm; PϽ0.001).…”

Section: Restenosismentioning

confidence: 98%

Catheter-Based Therapy for Atherosclerotic Renal Artery Stenosis

White

2006

Circulation

110

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A therosclerotic renal artery stenosis (RAS) is more common than has been previously appreciated 1,2 and is an independent predictor of death regardless of the presence, severity, or method of revascularization of coronary artery disease. [3][4][5] Among 1235 patients undergoing diagnostic coronary angiography, multivariate analysis demonstrated that RAS (Ͼ50%) was a stronger independent predictor of all-cause mortality (relative risk [RR], 2.9; 95% confidence interval [CI], 1.7 to 7.0) than congestive heart failure (RR, 2.3; 95% CI, 1.3 to 4.1), elevated left ventricular ejection fraction (RR, 1.7; 95% CI, 1.2 to 2.2), or decreased renal function (serum creatinine) (RR, 1.3; 95% CI, 1.1 to 1.5). 3 A subsequent expansion of that study group, extended to 3987 patients undergoing abdominal aortography at the time of diagnostic cardiac catheterization, identified an incremental effect of the severity of RAS on the 4-year mortality rates. They found that a mild-to-moderate (50%) RAS was associated with a 30% 4-year mortality rate, which almost doubled (52%) with severe (Ͼ95%) RAS. 4 The cause-and-effect relation between RAS and death is uncertain. It is possible that the presence of RAS is simply a marker for more diffuse or extensive atherosclerosis, which would result in more vascular-related deaths. However, there is one study 5 that raises the possibility that the treatment of RAS with a renal stent in patients with renal insufficiency can improve mortality rates. In this trial, patients who improved their renal function after renal stent placement had significantly better survival rates compared with those whose renal function did not improve.A dedicated educational effort aimed at improving the diagnosis and treatment of peripheral arterial disease, including RAS, has been supported over the past 10 years by several professional societies. 6 -8 There is now objective evidence from the Medicare database that this effort to increase the number of patients with RAS who receive treatment has been successful, particularly among invasive cardiologists. 9 Defining the appropriate strategy for screening high-risk populations, determining the risk-to-benefit ratio for treatment, and avoiding complications of percutaneous renal revascularization is a continuously evolving process. PrevalenceAn ultrasound screening study in 834 free-living Medicare patients, with a mean age of 77 years, found significant (Ͼ60%) RAS in 6.8%. 10 There were almost twice as many men (9.1%) as women (5.5%, Pϭ0.053), with an even distribution among white (6.9%) and black (6.7%) participants. In a series of unselected autopsies in 221 patients older than 50 years, the prevalence of RAS (Ͼ50%) was 27%. 11 The prevalence of RAS rose to 53% if there was a history of a diastolic hypertension (Ͼ100 mm Hg).Renovascular hypertension is the most common secondary cause (Ϸ5%) of hypertension, and there are several clinical subsets of patients, particularly those with known atherosclerotic vascular disease, who have an increased incidence of RAS. 12,13 I...

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“…2,4,5) The percentage is quite consistent across different reports, although better results have been reported. 19,32) Worsening of blood pressure also occurs after the procedure. 4,5) Only if these formidable complications can be reasonably reduced will widespread adoption of PTRAS become more rational and persuading.…”

Section: Discussionmentioning

confidence: 99%

Delicate Percutaneous Renal Artery Stenting Minimizes Postoperative Renal Injury and Protects Kidney in Patients With Severe Atherosclerotic Renal Artery Stenosis and Impaired Renal Function

et al. 2005

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SUMMARYPercutaneous transluminal renal artery stenting (PTRAS) is associated with declining renal function in a non-negligible portion of patients and is inflicted by different mechanisms, including atheroembolism. This study investigated whether delicate PTRAS to reduce atheroembolism might minimize postoperative renal injury and better preserve renal function. Patients undergoing PTRAS performed by experienced interventional cardiologists, applying coronary intervention concepts, techniques, devices and delicacy principles whenever possible, were prospectively studied. A total of 34 patients (29 M/5 F) with impaired renal function (group A, creatinine 2.4 ± 0.1 mg/dL) and another 20 patients (16 M/4 F) with normal serum creatinine (group B, baseline creatinine 1.2 ± 0.0 mg/dL) were studied. PTRAS was successfully performed in all but one group A patient. During a 6-month follow-up, systolic and diastolic blood pressure (130 ± 2 versus 148 ± 4 mmHg, P = 0.001 and 70 ± 2 versus 78 ± 3 mmHg, P = 0.006) and serum creatinine (2.1 ± 0.1 versus 2.4 ± 0.1 mg/dL, P < 0.001) were all significantly lowered in group A patients. Using a 20% change cut-off value, renal function improved in eight (24%), remained unchanged in 24 patients (73%), and deteriorated in only one patient (3%). The corresponding alterations in blood pressure and renal function were insignificant in group B patients. Patients with bilateral involvement (eleven patients) also had significantly lowered serum creatinine on follow-up. In conclusion, delicately practiced PTRAS can reduce the rate of postprocedural renal deterioration in patients with impaired renal function, and should be adopted in every renal intervention. (

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Stents in the Treatment of Renal Artery Stenosis: Long-term Follow-up

Abstract: Renal artery stenting is safe, effective, and may be an alternative to surgery, particularly in ostial lesions. Our experience shows reduction in the restenosis rate compared to conventional angioplasty. All ostial stenoses should be stented.

Cited by 114 publications

References 26 publications

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

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

Catheter-Based Therapy for Atherosclerotic Renal Artery Stenosis

Delicate Percutaneous Renal Artery Stenting Minimizes Postoperative Renal Injury and Protects Kidney in Patients With Severe Atherosclerotic Renal Artery Stenosis and Impaired Renal Function

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