Serum Creatinine Stabilization Following Renal Artery Stenting

Abstract

The impact of renal artery stenting on renal function in a subgroup of consecutive de novo patients with atherosclerotic renal artery stenosis from the single operator, single center, retrospective renal stent trial is defined. Patients with inadequate preprocedure and/or follow-up renal function studies were excluded. Abnormal baseline serum creatinine (sCr) was defined as > or = 1.5 mg/dL. Follow-up sCr was improved, unchanged, or worsened if the variance from baseline decreased by >20%, stayed within 20%, or increased >20%, respectively. For the total cohort (194 patients), renal function stabilized or improved in 72% of patients. Plotting 1/sCr demonstrated a decline in renal function before the procedure that stabilized following renal artery stenting. Bilateral renal artery stenting predicted normal follow-up sCr, and baseline sCr >2.1 mg/dL was associated with improvement in sCr long-term. In conclusion, renal artery stenting results in overall stabilization of renal function, and bilateral renal artery stenting seems to have added benefit.

Update on intervention versus medical therapy for atherosclerotic renal artery stenosis

“…22,40-42 Other studies have noted that patients with a recent decline in glomerular filtration rate (GFR) derive the greatest benefit. 25,37,42-44 Bilateral stenting was found to improve or to stabilize renal function in some studies 32,37 but not in others. 16,21,29,38,43-45 Bilateral disease was noted to adversely affect survival, 22,40 whereas baseline stenosis 32 and good left ventricular function 39 were found to be predictors for improved renal function.…”

“…Multiple trials noted protective effects of distal protection devices during RASt. 37,46,47 None of the recent clinical trials (CORAL, ASTRAL, STAR, RAS-CAD) showed improvement in renal function with RASt. The ASTRAL trial reported higher creatinine values at 5 years for both the stenting and medical therapy groups, although higher in the stenting group, but no change or difference was reported.…”

“…Various study results suggest that patients with baseline 17,26,37,38 or more severe 24,31,39 renal dysfunction are more likely to have improved or stabilized renal function after stenting. Others reported that patients with poor baseline renal function were less likely to improve after stenting 31 or had associated increased mortality.…”

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

“…We have previously reported our extensive experience with renal artery stenting for atherosclerotic lesions. [8][9][10][11][12] There are only a few studies that have analyzed long-term outcomes after endovascular therapy for RAFMD, therefore, this report will analyze the short and long-term outcomes of patients undergoing endovascular treatment for RAFMD.…”

Ten-year experience with renal artery in-stent stenosis

“…[6][7][8] Factors affecting the need for target vessel revascularization (TVR) after renal stenting include solitary kidney, stent diameter Ͻ5 mm, age Ͻ67 years, peripheral arterial disease, and stroke. 6 Few studies have analyzed the management of recurrent symptomatic renal in-stent stenosis.…”