The long-term effect of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function was assessed in 100 consecutive patients with atherosclerotic renovascular hypertension. Technical success rates (complete plus partial) of a first PTRA averaged 76.2%, 74.1%, and 67.7% for the unilateral (n=42), bilateral (n=27), and solitary (n=31) groups, respectively. Of the technical successes, 59% (43/73) experienced sustained blood pressure benefit (mostly amelioration) during a mean foUow-up period of 29 months. Rates of blood pressure benefit were similar in the three groups. Ostial lesions comprised the majority of blood pressure benefit failures. Repeat angioplasty in 14 patients resulted in a 71% technical success rate and a 50% blood pressure benefit rate during a mean follow-up period of 22 months. Long-term stability of mean serum creatinine level was observed after technically successful angioplasty in all three groups. Acute renal insufficiency, which was reversible in all but one patient, complicated 26% of the procedures. Mechanical complications occurred in 14% (20/145) of the arteries acted on; surgical intervention was required in five patients. The mortality rate was 2%. These results suggest that angioplasty is effective in both the long-term management of renovascular hypertension and the preservation of renal function hi a large fraction of patients with atherosclerotic renovascular hypertension. Among patients with accelerated or malignant hypertension, the prevalence of renovascular hypertension is about 30%. Moreover, it is estimated that up to 45% of patients with accelerated hypertension and renal insufficiency suffer from renovascular hypertension.

SUMMARY Nineteen stenotic arteries in 16 patients with severe renovascular hypertension of nonatherosclerotic nature (fibromuscular dysplasia in 13, neurofibromatosis in 3) were treated with percutaneous transluminal renal angioplasty. The procedure was technically successful in 12 of 14 (86%) stenoses in the fibromuscular dysplasia subgroup but in only one of five (20%) lesions in the neurofibromatosis subgroup. Hypertension was abated (3 patients) or disappeared (8 patients) in 11 of the 12 (92%) patients with fibromuscular dysplasia who had a technically successful angioplasty, an effect that was sustained at latest follow-up (avg, 37 mo; range, 10-73 mo). The only complication encountered was a retroperitoneal hematoma that resolved uneventfully. Coupled with those from other centers, the results of the present study indicate that angioplasty offers a strong potential for curability in patients with renovascular hypertension caused by fibromuscular dysplasia and that percutaneous transluminal renal angioplasty should be considered the treatment of choice for the initial management of all patients with fibromuscular renovascular hypertension. (Hypertension 7: 668-674, 1985) KEY WORDS • fibromuscular dysplasia • neurofibromatosis • interventional radiology balloon dilatation • renal hypertension • renal artery stenosis P REVIOUS reports have demonstrated that percutaneous transluminal renal angioplasty (PTRA) may effect dilation of nonatherosclerotic renovascular stenoses and thus remission of the associated secondary hypertension over a short-term follow-up period.

The clinical and angiographic features of cervical and ocular bruits were correlated in 50 consecutive patients with severe extracranial internal carotid artery occlusive disease. Cervical bruits, generally localized to the carotid bifurcation, were highly associated (P = 0.004) with "tight" (residual lumen less than or equal to 2 mm) internal carotid artery stenosis, but significantly less often with a widely patent or occluded internal carotid artery. Angiographic features of a "slow-flow" state through a patent, but "tight" stenosis were identified as the apparent explanation for the absence of bruit in some patients. A unilateral ocular bruit contralateral to the side of internal carotid artery occlusion occurred in 9 of 10 patients, more often than an associated cervical bruit, and was interpreted as a sign of augmentation flow.

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In seven patients, carotid arteriography and arch aortography were performed using a translumbar catheter exchange sheath which facilitated selective catheterization. No significant complications occurred. The translumbar approach is easier than the axillary approach, will result in fewer complications, and should be considered whenever a femoral arterial access is unavailable.