Renal artery angioplasty and stent placement: Predictors of a favorable outcome☆,☆☆
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.
References (33)
- et al.
Contemporary surgical management of renovascular disease
J Vasc Surg
(1992) - et al.
Percutaneous renal artery stent placement for hypertension and azotemia: pilot study
Am J Kidney Dis
(1996) - et al.
Renal artery stent placement: utility in lesions difficult to treat with balloon angioplasty
J Am Coll Cardiol
(1997) - et al.
Follow-up of primary Palmaz-Schatz Stent placement for atherosclerotic renal artery stenosis
Am J Cardiol
(1995) - et al.
The natural history of atherosclerotic and fibrous renal artery disease
Urol Clin North Am
(1984) Ischemic renal disease: an overlooked clinical entity?
Kidney Int
(1988)- et al.
Lesions of the renal artery
Am J Surg
(1964) - et al.
Effects of renal artery stent implantation in patients with renovascular hypertension presenting with unstable angina or congestive heart failure
Am J Cardiol
(1997) - et al.
Long-term experience in percutaneous transluminal dilatation of renal artery stenosis
Am J Med
(1985) - et al.
Acute renal failure after coronary intervention: incidence, risk factors, and relationship to mortality
Am J Med
(1997)
Natural history of atherosclerotic renal artery stenosis associated with aortic disease
J Vasc Surg
A prospective study of disease progression in patients with atherosclerotic renal artery stenosis
Am J Hypertens
Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization
J Am Soc Nephrol
Ten years experience with the surgical management of renovascular hypertension
Ann Surg
Captopril renography
Treatment of ostial renal-artery stenoses with vascular endoprostheses after unsuccessful balloon angioplasty
N Engl J Med
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2015, Journal of Vascular SurgeryCitation Excerpt :Attempts to identify patients who are most likely to benefit in renal function after intervention have been extensively studied. Various study results suggest that patients with baseline17,26,37,38 or more severe24,31,39 renal dysfunction are more likely to have improved or stabilized renal function after stenting. Others reported that patients with poor baseline renal function were less likely to improve after stenting31 or had associated increased mortality.22,40-42
Resistant hypertension: Medical management and alternative therapies
2015, Cardiology ClinicsCitation Excerpt :More than 90% of cases are atherosclerotic in origin, with a higher likelihood occurring in older patients with a history of smoking, known atherosclerotic disease, especially peripheral artery disease, DM, and sudden loss of renal function after the initiation of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ARB). Even though several, prospective, randomized trials over the past decade have failed to demonstrate clinical advantages to revascularization compared with medical therapy (Table 1), management of patients with renovascular disease remains controversial.34,53–58 Many criticized that these trials were subject to selection bias by excluding patients with severe cases of stenosis or HTN and progressive renal disease, and including patients with minor renovascular disease; therefore, the outcomes of these studies cannot be generalized to all patients.
Outcomes after stenting of renal artery stenosis in patients with high-risk clinical features
2024, Egyptian Heart Journal
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