Multicenter Palmaz stent renal artery stenosis revascularization registry report: Four‐year follow‐up of 1,058 successful patients

Abstract

Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 1,058 patients who were entered into a voluntary, multicenter registry. The revascularization procedures were performed because of poorly controlled hypertension, preservation of renal function, and congestive heart failure. All 1,058 patients were eligible for > or =6-month clinical follow-up, which focused on subsequent renal function, blood pressure, number of antihypertensive medications, and survival. At 4-year follow-up, systolic and diastolic blood pressures had significantly decreased (168 +/- 27 mm Hg to 147 +/- 21 mm Hg, and 84 +/- 15 to 78 +/- 12 mm Hg; P < 0.05) and the blood pressure appeared to be more facilely controlled as indicated by the concomitant decrease in number of antihypertensive medications (2.4 +/- 1.1 to 2.0 +/- 1.0; P < 0.05). Serum creatinine had also significantly decreased (1.7 +/- 1.1 to 1.3 +/- 0.8 mg/dl; P < 0.05). The cumulative probability of survival was 74% +/- 3% at 4 years. Survival was good for patients with normal (85% +/- 3%) baseline renal function, fair (78% +/- 5%) with mildly impaired renal function, and poor (49% +/- 5%) with severely impaired renal function (baseline creatinine > or =2.0 mg/dl). The combination of impaired renal function and bilateral disease adversely effected survival (unilateral 55% +/- 6% vs. bilateral 36% +/- 11%; P < 0.05). Renal artery stent revascularization, in the presence of normal or mildly impaired renal function, had a beneficial effect on blood pressure control and on renal function (through stabilization or improvement). Survival was adversely effected by renal dysfunction despite adequate revascularization. Perhaps early diagnosis of renal artery stenosis and adequate revascularization prior to the onset of renal dysfunction could beneficially impact blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival.

Predictors of Improved Renal Function After Percutaneous Stent-Supported Angioplasty of Severe Atherosclerotic Ostial Renal Artery Stenosis

“…Moreover, earlier studies included patients with moderate diameter stenoses (50% to 70%) that are unlikely to cause hemodynamic compromise. 14 -19,21-24,28,29,35 With an adequate sample size, improvement of renal function was found that was similar to that reported by van de Ven et al, 19 Iannone et al, 20 and Dorros et al 21,22 The choice of stent-supported angioplasty as treatment modality may have contributed to the beneficial outcome in the study. We were able to reduce the renin-angiotensin system to Ͻ30% in all cases.…”

Ischemic Nephropathy

“…Many of the renal functional outcomes of these series are summarized elsewhere (49,50). It should be emphasized that recent small, prospective trials of renal angioplasty (mostly without stents) in selected patients produced only modest improvements in BP (51)(52)(53).…”

Effectiveness of Management Strategies for Renal Artery Stenosis: A Systematic Review

“…Evidence was weak owing to sparseness of data or disagreement among studies on other baseline factors and outcomes (Table 4), including the presence of bilateral disease among patients having revascularization (25,27,34,37,39,40,45) or among those enrolled in natural history studies (55,56); the degree of kidney function (20,51) No study that met eligibility criteria reported analyses of whether periprocedural interventions, such as different …”