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

Abstract

Background-Percutaneous stent-supported angioplasty is a treatment option for atherosclerotic ostial renal artery stenosis. Improvement of renal function by such intervention, however, is controversial and thought to be limited to specific subsets, such as nondiabetic patients and bilateral stenoses. In this prospective study, we investigated predictors for improvement of renal function and blood pressure after renal artery stent placement. Methods and Results-The study included 215 consecutive patients with ostial renal artery stenosis of Ն70% diameter stenosis undergoing stent-supported angioplasty. The primary end point was decrease in serum creatinine concentration at 1 year; the secondary end point, decrease in average mean arterial blood pressure assessed by 24-hour monitoring.

Atherosclerotic Renal Artery Stenosis: Association with Emerging Vascular Risk Factors

“…Furthermore, following PTRA, creatinine clearance improved significantly compared with baseline in the 18 of the 25 patients that were eligible at the 6-month follow-up (median: 52 ml/min, range: 26–164, vs. median: 63 ml/min, range: 18–151, for baseline and 6 months after revascularization, p < 0.05). Other studies have similarly demonstrated that serum creatinine values can be used to predict improvement in renal function following PTRA [124, 125]. Furthermore, ARAS patients undergoing PTRA with creatinine values >300 µmol/l (3.9 mg/dl) have almost 5-fold higher mortality rates compared with patients with creatinine values <300 µmol/l (relative risk = 4.7, 95% CI = 2.0–11.0, p < 0.0005) [126].…”

Effect of Renal Artery Stenting on Blood Pressure, Glomerular Filtration Rate and Left Ventricular Mass in Hypertensive Patients with Severe Atherosclerotic Renal Artery Stenosis

“…(10,11,13,18), while no significant reduction in LVM occurred in 84 patients participating in the study of Marcantoni et al in 2012 (12). The reduction in systolic blood pressure was reported as an important associated factor in LVM improve- The function of aldosterone in causing left ventricular hypertrophy, independent of high blood pressure can be helpful in interpreting these findings (10).…”

Effects of Percutaneous Transluminal Renal Angioplasty on Office and Home Blood Pressure and Home Blood Pressure Variability in Hypertensive Patients With Renal Artery Stenosis

“…Although previous studies on the predictors of improved out-of-office BP after PTA are limited, high baseline BP and normal renal parenchymal thickness in ARAS 14 and short duration of hypertension in FMD 37 have been reported to be predictors of better BP reduction diagnosed using ambulatory BP monitoring and office BP, respectively. Our results suggested that, for the success of PTA treatment, out-of-office BP measurement after PTA is particularly important for patients with ARAS, longer duration of hypertension, or proteinuria.…”

“…[11][12][13] The evidence on the effects of PTA on not only out-of-office BP 14,15 but also BP variability is limited.…”