Renal artery angioplasty and stent placement: Predictors of a favorable outcome,☆☆

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Abstract

Background Renal artery stenosis is a common disorder and is an established cause of hypertension and renal insufficiency. Although treatment with renal artery stents has been shown to improve blood pressure and renal function for some patients, the patient population most likely to benefit is unknown. The current study was designed to determine which factors are predictive of improved blood pressure and renal function when patients with renal artery stenosis are treated with renal artery angioplasty and stent placement. Methods In a prospective evaluation 127 consecutively enrolled patients with renal artery stenosis in 171 vessels were treated with angioplasty and intravascular stents. Blood pressure and serum creatinine concentration were measured before stent placement and during the follow-up period. Results The mean length of the follow-up period was 15 ± 14 months. Mean systolic blood pressure improved among patients with hypertension (from 177 ± 26 mm Hg before stent placement to 151 ± 24 mm Hg 6 months after stent placement (P < .001). The greatest improvement occurred among those with the highest baseline systolic blood pressure. This beneficial effect on blood pressure was sustained for 3 years. Sex, age, diastolic blood pressure, number of vessels into which stents were placed, serum creatinine concentration, presence of bilateral disease, race, and severity of stenosis were not predictive of improved blood pressure. Mean creatinine concentration was not significantly changed for the group as a whole. A significant decrease in serum creatinine concentration occurred among 43% of patients with baseline renal insufficiency. None of the examined variables was predictive of improvement. Conclusions Renal artery angioplasty and stent placement produced a significantly greater reduction in systolic blood pressure among patients with the highest baseline systolic blood pressure. Other examined variables were not predictive of a significant improvement in blood pressure. No examined variable was predictive of improved renal function. We concluded that management of renal artery stenosis with renal artery angioplasty and stent placement is most likely to result in significant improvement in systolic blood pressure among patients with the highest baseline systolic blood pressure. (Am Heart J 2000;139:64-71.)

Section snippets

Methods

The study included 127 consecutively enrolled patients with ≥60% stenosis of the renal artery or a ≥20 mm Hg translesional pressure gradient. All patients with significant renal artery stenosis were offered participation. Before enrollment written informed consent was obtained for a study protocol approved by the institutional review board. Significant renal artery stenosis was defined as the presence of a stenotic lesion causing ≥60% reduction in diameter according to digital caliper

Patient Population

Between July 1993 and February 1998, 127 patients with substantial renal artery stenosis involving 171 renal arteries were consecutively enrolled. The mean length of the follow-up period was 15 ± 14 months (range 1 to 52 months). Two patients died before their first follow-up visit. Follow-up data collection was complete for all other patients. The study group included 58 men and 69 women with a mean age of 69 ± 11 years (range 36 to 91 years) of whom 117 (92.1%) were white, 5 (3.9%)

Discussion

Considerable attention has been devoted in the last 2 decades to the topic of renal artery stenosis due to atherosclerosis. The concerns are the frequency of the disease (10% to 20% among older patients undergoing coronary angiography)1 and an increase in blood pressure or decrease in renal function caused by stenosis. The emergence of new options in the treatment of patients with renal artery stenosis is changing the approach to the disease in many centers. Treatment used to necessitate an

Acknowledgements

We thank the angiography team at the Medical College of Ohio for excellent technical support. We also thank Ms Sandy Tucker for secretarial assistance and Mr James Bangayan for expert assistance with statistical analysis.

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    Reprint requests: Mark W. Burket, MD, Department of Medicine, Medical College of Ohio, PO Box 10008, Toledo, OH 43699. E-mail: [email protected]

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