Distal Embolic Protection During Renal Artery Stenting: Impact on Hypertensive Patients With Renal Dysfunction

Abstract

Distal embolic protection (DEP) may prevent embolization of atherosclerotic debris during renal artery stenting. The authors retrospectively identified 48 hypertensive patients with chronic kidney disease (CKD) who underwent renal artery stenting between 2002 and 2005 and compared stenting alone (n=17) to stenting/DEP (n=31). Blood pressure (BP) and estimated glomerular filtration rate (eGFR) (mL/min/1.73m2) at baseline at 6 and 12 months were compared. Overall, eGFR improved by 4.7 (P=.005) at 6 months and 3.8 (P=.003) at 12 months compared with baseline. Comparing stent to stent/DEP patients, eGFR improvement did not differ at 6 months (7.6 vs 2.9; P=.15) or at 12 months (4.4 vs 3.5; P=.74). Systolic BP reduction was similar between stent and stent/DEP patients at 6 months (−9 vs −14 mm Hg; P=.59) and at 12 months (−18 vs −16 mm Hg; P=.89). Renal artery stenting improved eGFR and systolic BP in patients with hypertension and CKD; however, DEP did not enhance these effects.

Clinical Outcomes in Patients With Renal Artery Stenosis Treated With Stent Placement With Embolic Protection Compared With Those Treated With Stent Alone

“…In addition, we observed a significant improvement in eGFR for patients with stage 4 CKD at followup when compared with controls. We did not observe any changes in hypertension consistent with recent observations made by Singer et al 27 …”

Primary stenting for atherosclerotic renal artery stenosis

“…Effective antithrombotic treatment and use of distal embolic protection devices during the procedure could prevent the consequences of atheroembolism. However, a comparative study 16 and a RCT 17,18 did not find any convincing beneficial effect of protection devices on clinical outcome (Table III). In the RCT, no change was seen in glomerular filtration rate after intervention in a small patient subgroup that received abciximab and a distal protection device, whereas glomerular filtration rate declined in the other three groups.…”

Successful Percutaneous Renal Artery Angioplasty and Stenting for Acute Oliguric Renal Failure in a Solitary Functioning Kidney Caused by Takayasu's Arteritis

“…To minimize contrast induced nephropathy, we administrated sufficient amounts of saline and acetylcysteine before the procedure and used the iso-osmolar contrast agents followed by hemodialysis after intervention based on previous recommendations in the medical literature 6)8)12). The usefulness of distal protection device or carbon dioxide angiography in renovascular intervention has been controversial and we chose not employ them for our patient 13)14). Long term complications of PTA/stenting include restenosis, thrombotic occlusion, stent fracture and migration.…”