Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis

Ramos, Felipe; Kotliar, C.; Álvarez, Daniel; Baglivo, Hugo; Rafaelle, Pablo; Londero, Hugo; Sánchez, Ramiro; Wilcox, Christopher S.

doi:10.1046/j.1523-1755.2003.00734.x

Cited by 74 publications

(44 citation statements)

References 29 publications

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“…[27][28][29][30][31] For patients with a normal or mildly impaired renal function, however, it is unclear if and when intervention should be performed to prevent progressive renal failure, because the rate of progressive narrowing of the renal artery and the associated rate of progressive renal failure is generally slow. 32 Our study shows that intervention should not be postponed in patients with bilateral stenosis, even if their renal function is not impaired as yet.…”

Section: Discussionmentioning

confidence: 99%

Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?

et al. 2004

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Section: Discussionmentioning

confidence: 99%

Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?

et al. 2004

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“…Despite the small number of patients involved in this study, the sample tried to select the cases with a clear clinical indication for percutaneous renal revascularization, either to control systemic hypertension or to preserve or restore renal function 3,12,20,21 . In fact, several studies have evaluated the renal function after renal angioplasty with stent placement 10,11,[16][17][18][20][21][22][23] . A study carried out by Jensen 24 evaluated 107 patients with ARAS in a one-year follow-up after stenting in renal artery and found that this group showed decreased BP and increased glomerular filtration rate.…”

Section: Discussionmentioning

confidence: 99%

“…Renal USDoppler was used since it is sensitive to detect post-stenting renal artery stenosis 18,19 . The literature reports post-stenting renal artery stenosis rates of 15% 20 .…”

Section: Discussionmentioning

confidence: 99%

Eficácia clínica da revascularização renal percutânea com implante de stent em pacientes com doença renovascular aterosclerótica

Gonçalves¹,

Amorim²,

Neto³

et al. 2007

Arq. Bras. Cardiol.

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Objective: To evaluate the clinical efficacy of percutaneous renal revascularization with stenting to control hypertension and preserve/restore renal function in patients with atherosclerotic renovascular disease. Methods:From May/1999 to October/2003, 46 patients with atherosclerotic renal artery stenosis (ARAS) underwent revascularization with stenting. The indication for the procedure was hypertension control and/or renal function preservation/ restoration. Clinical characteristics: age range: 33-84 years (median = 58.5 ±10.7), males: 26 (56.5%), 4 (10%) patients with dia betes mellitus, 21 (46%) patients with coronary artery disease, creatinine <2.0mg/dl: 39 (64%), 6 patients (14%) with congestive heart failure, 20 (43%) patients with ostial stenosis and 15 (33%) patients with bilateral stenosis. Hypertension control was evaluated by the number of drugs used before the procedure and at follow-up (FU) and by blood pressure (BP) measurement. Results:The minimum follow-up was 7 months (range of 7-52, median: 23, mean: 24.2 ± 15.2). There were no major complications. No patient experience any cardiovascular event. There was only one non-cadiac death (2%) and one technical failure in the treatment(2%). There was no serious complication in the procedure. None of the patients presented cardiovascular events. The renal function improved or stabilized in 32 patients (82%) and worsened in 4 (10%). The BP control improved in 19/44 (43,8%) patients and worsened / stabilized in 6 patients (14%). Conclusion:Angioplasty with renal artery stenting for ARAS showed to be an effective treatment strategy to restore and preserve renal function and to control blood pressure. Atherosclerotic renal artery stenosis (ARAS) is one of the causes of systemic hypertension (SH) and renal failure 1-3 . Its real prevalence is unknown, but it is estimated that up to 5% of hypertensive patients have ARAS as the etiology of SH. The clinical relevance of ARAS has increased due to global longer life expectancy and higher prevalence of SH and diabetes mellitus 4,5 . In this group of patients, the simultaneous occurrence of atherosclerosis in different sites is very common 6 . A study carried out by Baboolal, in 1998, described the mortality, the rate of renal function decrease and the incidence of end-stage renal disease in 51 patients with bilateral ARAS, who were followed up during a mean of 52 months 7 . Such patients did not undergo percutaneous or surgical intervention. The evaluation of renal function showed impairment at the time of angiography and a variable, non-uniform decline during the observation period. After 5 years, there was a progressive increase in the incidence of end-stage renal disease (ESRD). Six out of 51 patients who were evaluated with angiography presented ESRD. The therapeutic resources for ARAS are the control of SH and other risk factors for cardiovascular events and renal revascularization, which can be achieved by surgery or angioplasty (with or without stent placement).Percutaneous revascularization techniques are...

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“…It is likely that a stenosis of much greater severity is required to generate the renin, other mediators and hypertension from an affected kidney. A recent study from Ramos and colleagues 14 showed that when an arterial stenosis of 70% with a trans-lesion pressure gradient430 mm Hg was defined as the lower limit of significance, angioplasty offered a significant reduction in BP, with a modest increase in glomerular filtration rate. These data are from an observational study rather than a clinical trial but at least point the way towards the demonstration that relief of a severe stenosis may be of value.…”

Section: Discussionmentioning

confidence: 99%

Grand Rounds at the British Hypertension Society: renal artery stenosis

2007

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Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis

Cited by 74 publications

References 29 publications

Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?

Which patients with hypertension and atherosclerotic renal artery stenosis benefit from immediate intervention?

Eficácia clínica da revascularização renal percutânea com implante de stent em pacientes com doença renovascular aterosclerótica

Grand Rounds at the British Hypertension Society: renal artery stenosis

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