Ostial versus Truncal Renal Artery Stenosis: Predictor of Large Artery Atherosclerosis Severity and Higher Mortality

Abstract

SUMMARYThe aim of this study was to determine arterial stiffness and the effect of stenting in patients with renal artery stenosis. We hypothesized that ostial renal artery stenosis is not only a marker of more pronounced atherosclerosis of large arteries, but is also a predictor of higher cardiovascular mortality. We enrolled 33 patients with renal artery stenosis refractory to pharmacological treatment and divided them according to the renal artery stenosis location, ostial and truncal (23 vs. 10 patients). We analyzed patient survival at five-year follow up. After the intervention and at six-month follow up, there was a significant decrease in blood pressure values, as well as in pulse wave velocity (PWV) and augmentation index. PWV was significantly lower in patients with truncal renal artery stenosis and these patients were significantly younger. Twelve patients with ostial and one patient with truncal renal artery stenosis (52% vs. 10%, p<0.001) died from cardiovascular events. Our study is the first to confirm the predictive role of PWV and arterial stiffness in patients with renal artery stenosis, especially ostial one, and to emphasize its ability of detecting future higher incidence of cardiovascular events.

Analysis on the correlation between the occurrence of vertebral artery ostium stenosis and the severity of osteoporosis in elderly patients with atherosclerosis

“…The studies (5) have shown that osteoporosis is closely related to cardiovascular disease and AS disease, and the probability of VAOS in AS disease patients is as high as 40%. At the same time, from the anatomical and physiological perspective, the anatomical composition of vertebral artery is closely related to the bone of the cervical vertebral body, so we speculated a certain correlation between VAOS and osteoporosis (6,7). Based on this, this study will compare AS patients with and without VAOS.…”

Simple clinical scores to predict blood pressure and renal function response to renal artery stenting for atherosclerotic renal artery stenosis

“…In another small study that included only patients with baseline serum creatinine >1.5 mg/dL but less than 4.0mg/dL and bilateral RAS or single functional kidney in the context of ARAS, RF improved or stabilized in all patients after PTA [6]. Several other factors have been indicated in their association with a reduced likelihood of a favorable RF response, including age >65 years, male sex, severe atherosclerotic disease, proteinuria >1 g/day, severely impaired RF (eGFR<40 ml/min), diabetes mellitus, RAS degree <70% are postulated [29,33,34]. Our data are consistent with these findings as (having recruited patients with a significant angiographic ARAS that required confirmation on renal artery flow impairment by ultrasonography) we show that eGFR less than 30ml/min/1.73m 2 lowers the likelihood of favorable RF response ( Table 3).…”

“…Despite a general agreement on the role of baseline RF and kidney parameters in predicting the RF response [13,15,30,32,33], the RF response to ARAS-PTA has been even more controversial than the BP response. Kalra et al [13] reported that ARAS revascularization in chronic kidney disease (CKD) stages 3-5 was independently associated with improvement in RF at 1 year.…”

Renal Artery Stenosis, Diagnosis and Management: a Literature Review

“…Необходимо обратить внимание на характер АГ. Для ВРГ характерно внезапное появление АГ в возрасте после 50 лет, стремительное развитие гипертонии, устойчивость к гипотензивной терапии [20]. Характерно злокачественное, осложненное течение гипертензии с повреждением органов-мишеней -выраженной гипертрофией миокарда, застойной сердечной недостаточностью, нарушением зрения (ретинопатией), неврологической симптоматикой.…”