Plasma Fibrinogen as a Risk Factor for Restenosis after Percutaneous Transluminal Renal Angioplasty in Patients with Atherosclerotic Renal Artery Stenosis

Abstract

Background In contrast to those for coronary restenosis, the data regarding the risk factors for renal restenosis are limited.Objective To evaluate potential humoral risk factors for restenosis after percutaneous transluminal renal angioplasty (PTRA).Methods We studied 27 patients aged 54 ± 10 years with atherosclerotic renal artery stenosis in a 1-year prospective follow-up. Restenosis (confirmed by angiography) occurred in eight patients 1-6 months after PTRA. We detected no Doppler ultrasound evidence of restenosis in 19 patients throughout 1 year. Blood studies were done before PTRA for all patients, at the time of diagnosis of restenosis and, for those without restenosis, after 1 year. including determinations of fibrinogen, lipids, platelets and leukocytes. ResultsThe mean level of fibrinogen in patients who experienced restenosis was higher than that in those who did not (450 ± 150 mg% versus 337 ± 57 mg%, P <0.0 1) and remained unchanged for both groups during follow-up. The other parameters did not differ between the groups before PTRA and did not change over time, with the exception of platelet count in patients who did not experience restenosis, which had decreased from 253 ±93 Gil to 200 ±63 Gil (P<O.01) 1 year after PTRA. The logistic multiple regression analysis disclosed that an increment of fibrinogen level by 100 mg% was linked with an odds ratio for restenosis of 3.2 (95% confidence interval 1.1-9.8).Conclusions Restenosis was associated with higher than normal levels of fibrinogen before PTRA. A high plasma fibrinogen level might playa role in the development of restenosis after PTRA.

The effect of carotid stenting on rheological parameters, free radical production and platelet aggregation

“…These results are in keeping with an earlier study by Schillinger et al who investigated the levels of CRP and serum amyloid A (SAA) in connection with acute phase reactions [24]. They found that the level of these markers were significantly higher within 48 hours following intervention.…”

“…Several earlier studies have been involved in investigating the possible role of hemorheological and hemostaseological changes in restenosis following endovascular intervention [7,8,[20][21][22][23][24][25][26]. In an earlier study of patients following PTCA we found that the RBC count, plasma viscosity and total blood viscosity decreased significantly within 30 minutes following intervention, the RBC count increased in conjunction with the total blood viscosity until the six month-follow up.…”

“…There have been several previous studies investigating the effect of the endovascular treatment of the coronaries on the hemostaseological and hemorheological conditions as well as on free radical production [7,9,10,22,24,32]. However, there is few data on the similar effects of endovascular treatment of the carotid arteries.…”

Plasma Lipoprotein(a) Levels and Atherosclerotic Renal Artery Stenosis in Hypertensive Patients

“…Later on, this association was confirmed in hypertensive patients with narrowing of a renal artery by 50% or more [44]. Furthermore, in 27 patients with ARAS fibrinogen levels were related to an increased rate of restenosis after 1 year of renal artery angioplasty [22]. Levels of homocysteine were reported to be higher in 58 patients with angiographic evidence of ARAS and impaired renal function than in normotensive subjects [23].…”

“…Among these conditions, elevated lipoprotein(a) levels and a prothrombotic state might be of particular interest because both have been shown to have specific relevance for the development of organ damage in hypertensive patients [19,20]. Previous studies have suggested a possible contribution to ARAS of plasma fibrinogen [21,22] and homocysteine [23] levels, whereas the role of lipoprotein(a) remains unclear [21,24,25], most likely because none of the studies conducted so far has been specifically designed to investigate its role. This study was designed to investigate whether plasma levels of lipoprotein(a) and hemostatic and fibrinolytic markers are associated with ARAS and can predict its presence in hypertensive patients.…”