Clinical efficacy of percutaneous renal revascularization with stent placement in hypertension among patients with atherosclerotic renovascular diseases

Abstract

Aim:The aim was to assess the effect of renal angioplasty with stent on systolic, diastolic, and mean arterial blood pressure (MAP) in awake and sleep time with ambulatory blood pressure (ABP) monitoring (Holter monitoring).Materials and MethodsPatients with angiographically proven atherosclerotic renal artery stenosis (RAS) were referred to the Angiography Department of Imam Hospital for intervention during a 1-year period from June 2008 to December 2009. Primary stent placement was attempted by a single operator in 27 severe RAS cases although 1 case was omitted from the study because of technical failure. Pre- and postprocedure creatinine levels, ejection fraction (EF), history of diabetes mellitus (DM), and ABP were obtained. Twenty-six (17 men, 9 women; average age, 62.6 years; age range, 90-21 years) consecutive patients participated in the study.Results:All patients had severe hypertension resistant to multiple medications; 10 patients had impaired renal function (serum creatinine level greater than 130 µmol/L). A total of 3 (11.5%) patients had congestive heart failure, and 10 (37.7%) were diabetic. Hypertension was cured in 1 (4%) patient, had improved in 23 (88.4%) patients, and had failed to respond to treatment in 2 (7.6%). Serum creatinine decreased significantly from 1.46 ± 0.89 to 1.35 ± 0.61 mg/dL (P<0.05).Conclusion:Percutaneous transluminal angioplasty for atheromatous RAS rarely cures hypertension, but improved blood pressure control is often achieved.

Successful percutaneous transluminal angioplasty for the treatment of renovascular hypertension with an atrophic kidney

“…The effectiveness of angiotensin-converting enzyme and angiotensin II receptor blockers has made it easy to control blood pressure in patients with RVH [ 11 ]. On the other hand, several studies showed the effectiveness of PTRA with or without stent placement [ 12 , 13 ]. A prospective study investigating the efficacy of stent revascularization for the prevention of cardiovascular and renal events among patients with renal artery stenosis is ongoing [ 14 ].…”

Research of multiarterial atherosclerotic disease in hypertensive patients with renal artery stenosis

“…2,15,23,25 Além da hipertensão arterial, a estenose de artéria renal, especialmente quando a etiologia é ateroscleró-tica, pode causar insuficiência renal, principalmente quando a estenose é bilateral, por meio da nefropatia isquêmica crônica. 6,26 Tal complicação pôde ser também observada em nosso estudo, visto que alguns pacientes já estavam em tratamento conservador para doença renal crônica e alguns outros já apresentavam alterações dos níveis séricos de creatinina, indicando uma possível evolução desfavorável da função renal. Estima-se que cerca de 12% a 16% dos pacientes com insuficiência renal crônica terminal tenham como causa de lesão renal a estenose de artéria renal, provocando nefropatia isquêmica, principalmente quando a estenose é bilateral [27][28][29] .…”