Percutaneous Transluminal Angioplasty of Renal Artery Fibromuscular Dysplasia: Mid-term Results

Abstract

ObjectiveTo evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD).Materials and MethodsBetween March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated.ResultsThe technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA.ConclusionPercutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA.

Percutaneous transluminal angioplasty with selective stenting for the treatment of renal artery stenosis caused by fibromuscular dysplasia: 18 years' experience from the China Center for Cardiovascular Disease

“…Restenosis after PTA is a key factor affecting blood pressure outcomes. According to the literature, the incidence of restenosis is 15–35% . However, studies indicate that most patients benefit from secondary PTA treatment and this study showed similar results.…”

Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions

“…For lesions resistant to traditional balloon angioplasty, cutting or scoring balloons have been used, but they potentially carry a higher risk for arterial rupture and are not recommended by this writing committee. [200][201][202] The post-PTA arteriographic appearance of the renal artery may be suboptimal, or the artery may look normal when it is not. Thus, it is important to be certain that the pressure gradient is obliterated to confirm success of the intervention 1 ( Figure 8).…”

“…186,194 Monitoring by CTA is less studied, with 1 series describing restenosis in 4 of 18 segments (22%) from 12 patients over a mean of 18.3 months. 200 Therefore, restenosis occurs in ≈25% of patients within 1 year after PTA. In a review of published case series of PTA for FMD with reported rates of imaging findings of restenosis, it is unclear whether these findings in fact truly represent restenosis or patients who were suboptimally treated initially.…”

Diagnosis, management, and future developments of fibromuscular dysplasia

“…Usually a second PTA results in cure or improvement in blood pressure. 63,80 It is important to measure pressure gradients both before and after angioplasty to be certain that all of the webs have been disrupted and the pressure gradient has been obliterated. 40,41,65 IVUS imaging may be a useful adjunct to demonstrate not only the type of FMD involved 29 but also the disruption of the webs after the intervention.…”

“…PTA results in blood pressure reduction in most patients and can be used to treat every type of lesion in the main and branch arteries (Table II). 63,[70][71][72][73][74][75][76][77][78][79][80][81][82] In an effort to determine the rate of cure of hypertension after angioplasty or surgery, Trinquart et al 64 performed a systematic review and meta-analysis of 47 angioplasty studies (1616 patients) and 23 surgery studies (1014 patients). Cure of hypertension, defined according to the criteria in each study, was estimated to be 46% (95% confidence interval, 40%-52%) after angioplasty and 58% after surgery (95% confidence interval, 53%-62%).…”