Percutaneous Transluminal Renal Angioplasty in Patients with Renovascular Hypertension: Long-Term Results.

Abstract

This study evaluated the long-term effects of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function in patients with renovascular hypertension. Seventy-eight patients with hypertension and unilateral or bilateral stenoses of the renal arteries (16 with fibromuscular dysplasia and 62 with atherosclerosis) were studied. All patients with fibromuscular dysplasia (group A) had normal renal function, while 27 of the 62 patients with atherosclerosis (group B) presented with various degrees of renal failure. PTRA was technically successful in 87.5% patients of group A. The overall technical success rate (complete plus partial) was 72.3% (55/76 renal arteries) in group B. Mean follow-up (range) in months was 42 (12-108) for group A and 39 (13-106) for group B. After successful PTRA, the overall benefit rate (cure plus improved) for hypertension was 100% in group A; 10 of 14 patients were cured and 4 of 14 were improved. In group B, the overall benefit rate was 70.8% ; 9 of 48 were cured and 25 of 48 were improved. PTRA was technically successful in 18 of 27 patients with renal failure. Renal function improved in 4 of 18 patients, remained stable in 9 of 18, and deteriorated in 5 of 18 patients. The above results suggest that PTRA is an effective method for the long-term management of patients with renovascular hypertension, although the results were less favorable in the presence of bilateral renal artery stenoses: in addition to improved control of blood pressure, PTRA might improve renal function or delay its progressive deterioration. (Hypertens Res 1995; 18: 27-31)

Stent Placement for Renal Arterial Stenosis: Where Do We Stand? A Meta-analysis

“…The results of stent placement in patients with renal arterial stenosis were compared with the results of renal PTA in a similar patient group (10 articles, 644 patients [261 men, 218 women, 165 sex not mentioned], 778 arteries). Because the majority of stent studies were published from January 1995 to August 1998, studies dealing with renal PTA for renal arterial stenosis published in the same period were included to obtain contemporary controls (3,(21)(22)(23)(24)(25)(26)(27)(28)(29). The following parameters were compared between the stent studies and the renal PTA studies: indication for intervention, initial technical success, complication rate, percentage of patients in whom hypertension or renal function was cured or improved, and restenosis rate.…”

Prevalence and Outcome of Renal Artery Stenosis in Atherosclerotic Patients with Renal Dysfunction.

“…Therefore, 22 patients without RAS and 20 patients with RAS were treated medically. Revascularization techniques, including surgery and percutaneous angioplasty, have recently been reported to be effective in blood pressure control and preservation of renal function in patients with atherosclerotic renovascular disease (19)(20)(21), whereas other studies have reported that these procedures offer no advantage over drug therapy for the treatment of patients with hypertension (22,23). The long-term effects of angioplasty on renal function remain to be determined.…”

Successfully Treated "Accelerated" Renovascular Hypertension with Intravascular Stenting.

“…In the past, medical therapy with angiotensin converting enzyme inhibitors has generally been the preferred treatment for older patients with renal artery stenosis, since conventional balloon angioplasty for atherosclerotic lesions has shown a lower initial success rate and higher restenosis rate as compared with fibromuscular dysplasia (1,3). However, the introduction of stenting has brought about a dramatic improvement in PTRA (4)(5)(6). In the present case, angioplasty with stenting at the bilateral renal artery stenosis of atherosclerotic lesions was effective for blood pressure control and preservation of renal function.…”