Angiographic Index for Angioplasty-Treatable Atheromatous Renal Artery Stenosis

Tanemoto, Masayuki; Abe, Michiaki; Uruno, Akira; Abe, Takaaki; Ito, Sadayoshi

doi:10.1291/hypres.31.881

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…We previously found that an angiographic index, the minimal diameter, could represent the hemodynamic significance of ARAS and that a hemodynamic index, PG/pre, could predict the BP reduction by PTRA-S treatment for ARAS. 8,10 Therefore, in combination with previous findings, the findings of this study present the strategy for ARAS described below. For reno-preservation, PTRA-S should be performed in cases at CKD stages 4-5 regardless of the hemodynamic significance.…”

Section: Discussionsupporting

confidence: 73%

“…The severity of ARAS was indicated by the width at the narrowest part and the % diameter reduction, which was calculated as 100Â(1Ànarrowest part width/reference width). 10 In all, 33 cases with unilateral ARAS of the narrowest part width o3 mm or a % diameter reduction 450% were included in this study. In all cases, ARAS was treated using PTRA-S (Palmaz stent, diameter: 5-7 mm).…”

Section: Methods Subjectsmentioning

confidence: 99%

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Stage of chronic kidney disease is an outcome-predicting factor of angioplasty for atheromatous renal artery stenosis

et al. 2010

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Angioplasty with insertion of an endoprosthesis is an effective treatment for atheromatous renal artery stenosis (ARAS). However, this procedure may cause deterioration in renal function, and it is imperative to define the cases that could benefit from angioplasty. From 456 suspected renovascular hypertension cases, 33 were given a diagnosis of unilateral ARAS on renal arteriography. These unilateral ARAS cases were treated by angioplasty, and their baseline variables were evaluated with respect to the improvement achieved in post-angioplastic renal function of the treated side as measured by renal scintigram. The estimated glomerular filtration rate (eGFR) was the only variable that was significantly different between cases that showed improvement in renal function and those that did not. Cases that showed improvement in renal function had lower preangioplasty eGFR compared with cases that did not show improvement (59 ± 24 ml min À1 1.73 m À2 vs. 76 ± 12 ml min À1 1.73 m À2 , P¼0.04), and cases showing improvement were generally at later stages of chronic kidney disease (CKD). Most patients without improvement, who were generally at earlier stages of CKD, had a systemic blood pressure reduction after angioplasty. The present findings indicate that the baseline CKD stage could be used to predict the outcome of angioplasty for ARAS.

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Section: Discussionsupporting

confidence: 73%

Section: Methods Subjectsmentioning

confidence: 99%

Stage of chronic kidney disease is an outcome-predicting factor of angioplasty for atheromatous renal artery stenosis

et al. 2010

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“…Previously, we showed that the minimal lumen diameter Ͻ3 mm could be a good angiographic index to select ARAS for angioplasty; it could select the angioplasty-efficacious ARAS more adequately than % diameter reduction Ն50% and Ն75%, widely used angiographic indices for ARAS (10). Supporting this notion, most of ARAS with the mean phase PG/preBP Ͼ0.15 could be selected by the minimal lumen diameter Ͻ3 mm.…”

Section: Discussionmentioning

confidence: 80%

“…We evaluated the angiography of ARAS as described previously (10). In brief, the width of the renal artery was measured by a computerbased method on the arteriography with the narrowest image of ARAS.…”

Section: Evaluation Of the Arteriographymentioning

confidence: 99%

Hemodynamic Index of Atheromatous Renal Artery Stenosis for Angioplasty

Tanemoto¹,

Suzuki²,

Abe³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Trans-stenotic pressure gradient across the constriction (PG), a hemodynamic variable of atheromatous renal artery stenosis (ARAS), is a widely used indicator for angioplasty, but its association with the outcome of angioplasty has not been fully investigated.Design, setting, participants & measurements: In 34 hypertensive cases with unilateral ARAS, we evaluated hemodymanic variables of ARAS with reference to the systemic BP reduction after angioplasty as the outcome.Results: In each phase, PG divided by its corresponding prestenotic arterial BP (PG/preBP) had better association with the outcome than PG. The mean phase PG/preBP had the largest area under the curve in the receiver operating characteristic analysis (0.794) with the sensitivity/specificity of 0.957/0.545 for its cut-off >0.15. Although the plasma renin activity, which reflects the perfusion to renal parenchyma, was higher in the angioplasty-efficacious cases than in the angioplasty-inefficacious cases before angioplasty (7.8 ؎ 6.6 versus 3.4 ؎ 3.8 ng/ml/h, P ‫؍‬ 0.049), it was not generally reduced by angioplasty independent of the outcome.Conclusions: As the index to select ARAS for angioplasty, PG/preBP was better than PG and the mean phase PG/preBP could be the best. However, other factors such as the microvascular kidney disease, which affect the perfusion to renal parenchyma, would influence the outcome.

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Diagnosis and therapy of atheromatous renal artery stenosis

Tanemoto

2013

Clin Exp Nephrol

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Atheromatous renal artery stenosis (ARAS), a lesion of systemic atherosclerotic disease, is the leading cause of stenotic lesions in the renal artery, followed by fibromuscular dysplasia, a primary abnormality of the renal artery. As a result of several clinical trails, which failed to show an additional benefit of renal revascularization to medical therapy in ARAS, the treatment of ARAS has shifted, and renal revascularization is less commonly performed for ARAS. However, it is recognized that renal revascularization benefits some patients with ARAS. Advances in imaging modalities would allow more frequent detection of ARAS in a society with a growing elderly population, a group with an increased prevalence of systemic atherosclerotic disease. Therefore, it is imperative to identify the patients with ARAS who could benefit from renal revascularization. This review presents a strategy for the treatment of ARAS based on the results of our analysis.

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Angiographic Index for Angioplasty-Treatable Atheromatous Renal Artery Stenosis

Cited by 4 publications

References 25 publications

Stage of chronic kidney disease is an outcome-predicting factor of angioplasty for atheromatous renal artery stenosis

Stage of chronic kidney disease is an outcome-predicting factor of angioplasty for atheromatous renal artery stenosis

Hemodynamic Index of Atheromatous Renal Artery Stenosis for Angioplasty

Diagnosis and therapy of atheromatous renal artery stenosis

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