Restenosis Prevalence and Long-Term Effects on Renal Function after Percutaneous Transluminal Renal Angioplasty

Abstract

We studied the frequency of restenosis and the effects of percutaneous transluminal renal angioplasty (PTRA) on blood pressure (BP) and particularly on renal function in all patients in whom successful dilatation was performed. Restenosis was found in 42% of the patients with an atherosclerotic renal artery stenosis and in 22% of the patients with fibromuscular dysplasia. BP improvement was seen in 70–80% of the patients with unilateral stenosis or with successful bilateral dilatation (group I) whereas only seldom was an effect on BP observed in patients with more complicated disease, such as those with an occlusion of the contralateral artery (group II). Remarkably, however, both in group I and in group II, in about half of the patients an improvement in renal function was found, even 2–3 years after the procedure. Our results thus indicate that PTRA can be useful in preservation or even improvement of renal function, even if no effect on blood pressure can be expected.

Treatment of Ostial Renal-Artery Stenoses with Vascular Endoprostheses after Unsuccessful Balloon Angioplasty

“…These results are substantially better than those when balloon angioplasty alone is used for ostial lesions. [10][11][12][13][14][15][16] The long-term outcome in our patients, with reversal of hypertension in 16 percent and improvement in 62 percent, is similar to the results reported in previous studies. 34 Renal function in the 20 patients who had mild or severe renal dysfunction before the intervention did not change during followup.…”

“…The initial success rates range from 24 to 35 percent, [10][11][12][13] and the rates of recurrence of the lesions from 15 to 42 percent. [14][15][16] Therefore, this type of renovascular disease is commonly treated by primary surgical intervention. 13,17 To overcome the problem of elastic recoil after angioplasty, recent reports recommend different types of intravascular stents for the treatment of nonostial renal-artery stenoses.…”

Effect of Renal Artery Stenting on Renal Function and Size in Patients with Atherosclerotic Renovascular Disease

“…However, enthusiasm for "simple" balloon angioplasty of renal arteries was tempered by high rates of restenosis, particularly for aorto-ostial lesions, which were vulnerable to the effects of vessel wall recoil and the persisting encroachment of aortic atheroma. [15][16][17][18] Although surgery has long been considered the standard for renal artery revascularization, longitudinal studies have reported significant perioperative morbidity and operative mortality rates of up to 6%. 19 -22 Over recent years, endovascular stenting has tended to supersede simple balloon angioplasty or surgical revascularization as the procedure of choice in the treatment of RAS.…”

Restenosis after a first percutaneous transluminal renal angioplasty.

“…KremerHovinga et al 9 reported the frequency of restenosis after successful PTRA at 42% in atheromatous and 22% in fibromuscular stenoses, but they did not define restenosis and derived their restenosis rate estimations from only 24 patients with atheroma and nine with fibromuscular dysplasia. Among the published series describing the long-term outcome of at least 50 patients who had undergone a successful PTRA, 10 -20 several did not report the results of follow-up angiography or mentioned that follow-up angiography was performed in only a minority of patients, 10 ' 11 ' 13 -17 -20 generally selected on the basis of recurrent hypertension.…”

“…As shown in Figure 1, angiographic follow-up was not available in 10 patients, and, in another two patients, repeat angiogram was performed within 2 months after PTRA, a time interval too short to detect the process of restenosis. 22 9 after PTRA (77%). We established that our imperfect angiographic follow-up was not associated with a particular clinical profile and therefore did not reflect a selection bias, e.g., difference in age, etiology, initial BP or renal function, or gross difference in the immediate PTRA outcome (Table 1).…”