Restenosis following Percutaneous Renal Artery Revascularization

Abstract

Background/Aims: Restenosis following percutaneous transluminal renal angioplasty (PTRA) remains a concern even in the era of adjuvant stenting. The optimal form of therapy, and particularly the role of repeat PTRA in the treatment of recurrent hypertension associated with renal artery restenosis, is largely unknown. The aims of this study were to determine the risk factors for restenosis and to evaluate the blood pressure outcomes of patients who underwent repeat PTRA. Methods: Clinical and procedural characteristics of 32 patients who developed recurrent hypertension and renal artery restenosis were compared to a control group of patients who maintained renal artery patency and adequate blood pressure control after the first procedure. The groups were matched for sex and initial procedure date. Results: The restenosis group had a mean age of 71 ± 12 years, a female/male ratio of 24/8, an average blood pressure of 179/87 mm Hg, despite three antihypertensive medications, and a serum creatinine level of 1.5 ± 0.4 mg/dl. Repeat PTRA performed for clinically significant restenosis was 10.7 ± 8 months after the first procedure, and 17 of the 32 patients had a measurable blood pressure benefit at last follow-up (177 ± 119 weeks). The development of restenosis was positively associated with body weight (p = 0.003) and body mass index (p = 0.008), but independent of diabetes mellitus, hyperlipidemia, or statin therapy. Of the 15 patients who failed the second procedure, 4 went on to have third PTRA, none of whom had sustained benefit. Conclusions: An increased body mass index is associated with restenosis following initial PTRA. Patients with restenosis can be treated successfully with repeat PTRA which provides sustained improvement in blood pressure control in approximately half of these patients.

Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period

“…Although others have documented independent risk factors for restenosis in RAFMD, including duration of hypertension and BMI, our study design and number of patients make this type of subgroup analysis difficult. 31 To the best of our knowledge, our current report is one of the largest reviews on RAFMD to date, as well as the longest follow-up study of patients with symptomatic RAFMD. However, our current study does have some limitations, including the retrospective design, which could have some bias toward selection criteria and the required follow-up components.…”

Restenosis after renal artery angioplasty and stenting: Incidence and risk factors

“…Previously described associations with restenosis or the need for repeat intervention after RA-PTAS include body weight and body mass index,11 renal artery diameter,5 stent diameter,9,10 and smoking 12. We were unable to specifically evaluate body mass index as a predictor of restenosis due to incomplete patient height data, but did not observe a significant relationship between weight or any of these other factors and restenosis in the present study.…”

“…Analyses to date have identified associations between restenosis after RA-PTAS and renal artery diameter,5,9 stent diameter,10 weight/body mass index,11 and smoking 12. The purpose of this study was to determine the frequency and predictors of restenosis after primary RA-PTAS in a single-center cohort of adult patients with atherosclerotic RAS.…”

ACE insertion/deletion polymorphism and restenosis events after coronary stent placement in East Azerbaijan Province of Iran

“…The identification of gene polymorphisms associated with restenosis can provide possible targets for gene therapy [8,[11][12][13][14][15][16][17]. The issue of the magnitude of the impact of common genetic polymorphisms on a complex disease such as CAD or post-angioplasty restenosis is contentious [2,12,15].…”