Carotid and Lower Extremity Arterial Disease in Patients With Renal Artery Atherosclerosis

Re, Zierler; Ro, Bergelin; Nl, Polissar; Kw, Beach; Mt, Caps; Cantwell-Gab, Kim; Rc, Davidson; De, Suvranu

doi:10.1001/archinte.158.7.761

Cited by 58 publications

(25 citation statements)

References 38 publications

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“…21 An overall trend for patients with increasingly severe renal artery disease to have increasingly severe degrees of carotid disease has also been reported. 22 The prevalence of severe renal artery stenosis among stroke patients with carotid arterial disease is as yet undefined.…”

Section: Discussionmentioning

confidence: 99%

Effect of Perindopril on Cerebral and Renal Perfusion in Stroke Patients With Carotid Disease

Walters

Bolster

Dyker

et al. 2001

Stroke

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Background and Purpose-The purpose of this study was to investigate the effect of the angiotensin-converting enzyme inhibitor perindopril on mean arterial blood pressure (MABP), cerebral blood flow (CBF), and glomerular filtration rate in hypertensive stroke patients with moderate to severe internal carotid artery (ICA) disease or ICA occlusion. Methods-Twenty-four nonacute ischemic stroke patients who had MABP readings Ͼ100 mm Hg and moderate to severe ICA stenosis or occlusion were randomized to receive perindopril 4 mg daily or placebo for 14 days. MABP, ICA flow, and both middle cerebral artery (MCA) velocity and resistance index were measured before dose, at 5 time points over the subsequent 24 hours, and finally at 2 weeks. Brain hexamethyl propylene amine oxide single photon emission computed tomography scans were performed before drug administration and at time of peak drug effect (6 to 8 hours) after the first dose. Glomerular filtration rate was measured with 51 Cr EDTA before medication and at 14 days. Results-A placebo-corrected BP fall of 17/10 mm Hg was seen (Pϭ0.017), which was maximal at 5.5 hours. No significant change in ICA flow or MCA velocity was seen between groups. No significant change in hemispheric CBF was seen. The mean change from baseline in the treated group was Ϫ0.79 mL · 100 g Ϫ1 · min Ϫ1 (95% confidence interval [CI], 1.65 to Ϫ3.23); mean change in the placebo group was Ϫ1.9 mL · 100 g Ϫ1 · min Ϫ1 (95%CI, 3.02 to Ϫ6.92). Peri-infarct CBF was similarly unaffected. One of the treated patients developed transient acute renal impairment and was withdrawn from the study on day 4. Conclusions-Perindopril

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Section: Discussionmentioning

confidence: 99%

Effect of Perindopril on Cerebral and Renal Perfusion in Stroke Patients With Carotid Disease

Walters

Bolster

Dyker

et al. 2001

Stroke

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“…(i.e., greater than 50%) have been reported in 11% to 18% of patients (621)(622)(623). Prevalence studies have also demonstrated significant RAS in 22% to 59% of patients with PAD (616)(617)(618)(619)(624)(625)(626)(627)(628)(629)(630). In one necropsy study, RAS greater than 50% was found in 53% of 295 unselected, consecutive examinations (631).…”

Section: Prevalence and Natural Historymentioning

confidence: 99%

“…Given the high prevalence of RAS in individuals with coronary artery disease (621,718,719) and peripheral vascular disease (619,(624)(625)(626)(627)(628)(629)(630) that warrant catheter angiography, the use of screening flush aortography (not selective renal angiography) at the time of coronary and peripheral vascular angiography has been proposed. Such studies may be appropriate (by operators skilled in the performance and evaluation of RAS using flush aortography) when individuals who will be undergoing coronary or limb angiography have clinical indicators for significant renal arterial occlusive disease.…”

Section: Magnetic Resonance Angiographymentioning

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

2,996

1,111

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“…Zierler et al [12]found that among such patients, 19% had severe carotid disease and 21% had severe peripheral vascular disease. In a similar study among patients with renovascular disease, 26% had moderate and 18% severe carotid stenosis [13].…”

Section: Introductionmentioning

confidence: 99%

Management of Resistant Hypertension in Patients with Carotid Stenosis: High Prevalence of Renovascular Hypertension

Spence

2000

Cerebrovasc Dis

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Introduction: Patients with carotid stenosis are at high risk of vascular events and therefore require an optimal control of risk factors such as hypertension. As the treatment of hypertension differs according to the cause, we examined the prevalence of resistant hypertension, and the cause of hypertension, among patients with carotid stenosis followed closely in two randomized trials of carotid endarterectomy. Objective: The purpose of this study was to determine the prevalence of resistant hypertension and of secondary hypertension among patients with carotid stenosis. Methods: A chart review was performed of all patients from our center who participated in the North American Symptomatic Carotid Endarterectomy Trial or the Asymptomatic Carotid Artery Study to determine the prevalence of renovascular hypertension. Results: Among 170 patients with carotid stenosis followed in these two trials, 145 (83.5%) were hypertensive (systolic >160 or diastolic >90 mm Hg); at least 24 (14.1% overall, 16.6% of hypertensives) had renovascular hypertension based on either nuclear medicine renography, renal angiography or both; among the 79 patients with resistant hypertension (mean arterial pressure >130 mm Hg despite treatment), 20 (25.3%) had renovascular hypertension. Adrenocortical hyperplasia was the underlying cause of hypertension in 12 (7.1% of cases, 8.3% of hypertensives, 8.8% of resistant hypertensives). Blood pressures were significantly higher for patients with renovascular and adrenocortical hypertension (p < 0.0001 for systolic, p = 0.024 for diastolic pressures). Conclusion: Among patients with carotid stenosis, renovascular hypertension is unusually common. Resistant hypertension among such patients should lead to investigation and management directed at the cause of hypertension. Appropriate investigations might include plasma renin/aldosterone ratio, captopril renography and MRA of the renal arteries or renal angiography.

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Carotid and Lower Extremity Arterial Disease in Patients With Renal Artery Atherosclerosis

Cited by 58 publications

References 38 publications

Effect of Perindopril on Cerebral and Renal Perfusion in Stroke Patients With Carotid Disease

Effect of Perindopril on Cerebral and Renal Perfusion in Stroke Patients With Carotid Disease

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

Management of Resistant Hypertension in Patients with Carotid Stenosis: High Prevalence of Renovascular Hypertension

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