Renal artery stent placement with use of the Wallstent endoprosthesis.

Abstract

The Wallstent endoprosthesis was placed in 12 renal arteries of 11 patients; a total of 15 stents were placed. Indications for placement were restenosis after dilation and insufficient result after dilation. In two patients, malpositioning of the stent required placement of a second stent. Complications included a case of massive cholesterol embolization and a case of unexplained transient hematuria, proteinuria, and deterioration of renal function. At repeat angiography of seven renal arteries after stent placement, one was occluded and required thrombolysis and dilation. Another showed restenosis due to shortening of the stent and required redilation and, later, placement of another stent. This stent became occluded after 1 month. In this patient and in three other cases, angiography disclosed tissue buildup in the stent but without significant stenosis after this short-term follow-up. After a clinical follow-up of 6.7 months +/- 3.4 in 10 patients treated for hypertension, three were cured, four were improved, and three were unchanged when blood pressure levels before stent placement were compared with those obtained after stent placement.

Delicate Percutaneous Renal Artery Stenting Minimizes Postoperative Renal Injury and Protects Kidney in Patients With Severe Atherosclerotic Renal Artery Stenosis and Impaired Renal Function

“…Renal atheroembolism and delicate PTRAS: Distal renal atheroembolism by PTRAS may be a crucial issue in patients with voluminous atheroma load and friable intima or in a protracted procedure, but is not often well appreciated. [33][34][35] This complication may occur microscopically or grossly, but is probably underrecognized due to large renal reserve. Guiding catheter intubation, primary stenting in the presence of very tight or friable atheroma, unnecessary balloon infla- tions before stenting, especially with large balloons and stiff wires, over-sized stents and high-pressure dilatation, unnecessary device manipulations and violent forces are all possible causes of distal embolism in PTRAS.…”

Flexible tantalum stents for the treatment of renovascular hypertension: a 10-year experience

“…With the use of different stent designs, high rates of initial technical success ranging between 78 and 100 % can be expected [6,7,8,9,10,11,12,13,14,15,16].…”

“…With self-expandable stents having a preset expanded diameter, this is not possible. Additionally, stent shortening of self-expandable stent designs may complicate correct stent positioning [6].…”

“…Although rigid stent designs were found to have especially high radial force in the in vitro experimental setting [21], in clinical use incomplete stent expansion does also occur with other stent designs [22]. This gives rise to the presumption that stent recoil may also be due to the characteristics of the treated lesion [6,10]. This is a problem, especially in ostial lesions, because these are caused mostly by bulky plaques along the aortic wall encroaching on and overlapping the origin of the renal artery in which cracking of the intima and remodeling of the plaque, constituting the classic mechanism of PTA, does not take place [23].…”

“…This may be due to the fact that PTRA is unsuccessful in 10±40 % of lesions, especially in ostial lesions [2,3,4,5]. With growing experience in arterial stenting, renal stenting has been accepted in recent years as a valuable therapeutic technique, providing better results than PTRA, and immediate success rates between 90 and 100 % [6,7,8,9,10,11,12,13,14,15,16]. Regarding long-term results, only few reports are available.…”