Stenting of renal artery stenosis preserves renal function in both diabetic and nondiabetic patients with chronic renal insufficiency

Abstract Background To evaluate the efficacy of endovascular therapy in patients with unilateral arteriosclerotic renal artery stenosis using nuclide renal dynamic imaging and to analyze the influencing factors that may affect the renal function. Methods A retrospective analysis was made on 60 patients with >70% unilateral arteriosclerotic renal artery stenosis who underwent renal artery stent implantation. Serum creatinine, urea nitrogen, renal artery color Doppler ultrasonography, and renal dynamic imaging results were obtained before and after 1 year of operation. A regression model was used to analyze the influencing factors. Results All patients underwent balloon dilatation and stenting of the affected renal artery. The immediate intervention success rate was 100%. The residual stenosis of the affected renal artery was less than 20%. No serious complications occurred during the perioperative period. After operation, systolic blood and diastolic blood pressures were improved (P < 0.01), the serum creatinine was stable (P = 0.25), and the degree of renal artery stenosis of the affected side was relieved significantly (P < 0.01). One year after operation, the patency rate of renal artery stent was 85%. Based on the changes of differential glomerular filtration rate of the affected side, 40 patients (66.7%) were improved while 20 patients (33.3%) were not. A linear regression analysis showed that the renal insufficiency of the affected side before operation was the only significant influencing factor (B = 0.50, P < 0.01). Conclusions Renal artery stenting is safe and effective in the treatment of unilateral renal artery stenosis. One-year patency rate is 85%. Two-thirds of the patients have an improved renal function after operation. The patients with preoperative renal insufficiency of affected side are more likely to benefit from renal artery stenting.

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Safety and Efficacy of Carbon Dioxide and Intravascular Ultrasound-Guided Stenting for Renal Artery Stenosis in Patients With Chronic Renal Insufficiency

Angiology ◽

10.1177/0003319714524297 ◽

2014 ◽

Vol 66 (3) ◽

pp. 231-236 ◽

Cited By ~ 8

Author(s):

Daizo Kawasaki ◽

Kenichi Fujii ◽

Masashi Fukunaga ◽

Nobuhisa Fukuda ◽

Tohru Masuyama ◽

...

Keyword(s):

Carbon Dioxide ◽

Renal Insufficiency ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Intravascular Ultrasound ◽

Chronic Renal Insufficiency ◽

Artery Stenosis ◽

Ultrasound Guided ◽

Safety And Efficacy

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Embolic Protection Devices in Patients with Renal Artery Stenosis with Chronic Renal Insufficiency: A Clinical Study

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2008.08.002 ◽

2008 ◽

Vol 19 (11) ◽

pp. 1639-1645 ◽

Cited By ~ 14

Author(s):

Sanjay Misra ◽

Manuel T. Gomes ◽

Verghese Mathew ◽

Gregory W. Barsness ◽

Stephen C. Textor ◽

...

Keyword(s):

Clinical Study ◽

Renal Insufficiency ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Chronic Renal Insufficiency ◽

Artery Stenosis ◽

Embolic Protection ◽

Protection Devices

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Stent-Supported Angioplasty of Severe Atherosclerotic Renal Artery Stenosis Preserves Renal Function and Improves Blood Pressure Control:Long-term Results From a Prospective Registry of 456 Lesions

Journal of Endovascular Therapy ◽

10.1583/03-1062.1 ◽

2004 ◽

Vol 11 (2) ◽

pp. 95-106 ◽

Cited By ~ 74

Author(s):

Thomas Zeller ◽

Ulrich Frank ◽

Christian Müller ◽

Karlheinz Bürgelin ◽

Lutz Sinn ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis ◽

Atherosclerotic Renal Artery Stenosis

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Clinical response scores to predict blood pressure and renal function improvement following renal artery stenting for atherosclerotic renal artery stenosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2721 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Kablak-Ziembicka ◽

A Roslawiecka ◽

R Badacz ◽

A Sokolowski ◽

P Musialek ◽

...

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Predictive Models ◽

Artery Stenosis ◽

Atherosclerotic Renal Artery Stenosis ◽

Baseline Serum ◽

Kidney Length

Abstract Background It is little known about predictors of systolic (SBP) and diastolic (DBP) blood pressure or renal function (eGFR) improvement in patients with atherosclerotic renal artery stenosis (ARAS) undergoing stent-assisted angioplasty (PTA). Therefore, we aimed to build a prediction scores that would indicate characteristics of patient subsets with ARAS most likely to have clinical improvement following PTA. Methods 201 patients who underwent PTA for ARAS (2003–2018) were categorized as eGFR or SBP/DBP responders based on eGFR increase of ≥11 ml/min/1.73m2, decrease of SBP ≥20mmHg and DBP ≥5mmHg at 12-months following PTA. The remaining patients were classified as non-responders. The performance of logistic regression models were evaluated by basic decision characteristics. Continuous data have been transformed into binary coding with help of operating characteristic (ROC) curve. Predictive models have been constructed for each followed by construction of predictive models in each of 3 categories. Results Logistic regression analysis showed that: baseline SBP>145 mmHg, DBP >82 mmHg, previous myocardial infarction and Renal-Aotric-Ratio >5.1 were independent influencing factors of SBP response, with relative risk percentage shares of 69.8%; 12.1%; 10.9%; and 7.2%, respectively (sensitivity: 82%, specificity: 86.3%, positive (PPV):82% and negative (NPV) predictive values: 86.3%). The DBP decrease prediction model included baseline SBP >145 mmHg and DBP >82 mmHg, the ARAS progression, index kidney length >106 mm, and bilateral PTA with respective shares of 35.0%; 21.8%; 18.2%; 13.3% and 11.8%. (sensitivity: 76%, specificity: 77.8%, PPV: 80.7% and NPV: 72.6%). The eGFR increase was associated with baseline serum creatinine >122 μmol/L but eGFR greater than 30 ml/min/1.73m2, index kidney length >98 mm, end-diastolic velocity in index renal artery, renal resistive index <0.74, and requirement for >3 BP medications, with respective shares of 24.4%; 24.4%; 21.2%; 15% and 15% (sensitivity: 33.3%, specificity: 93.5%, PPV: 65.6% and NPV: 78.9%). Conclusions Current study identified clinical characteristics of patients who most likely to respond to PTA for ARAS. The sutability of the score should be verified in a prospective cohort of patients referred to PTA of ARAS Funding Acknowledgement Type of funding source: None

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Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis

ACC Current Journal Review ◽

10.1016/j.accreview.2003.12.053 ◽

2004 ◽

Vol 13 (2) ◽

pp. 44

Author(s):

T. Zeller ◽

U. Frank ◽

C. Müller

Keyword(s):

Renal Function ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Artery Stenosis

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Predictors for Clinical Success at One Year following Renal Artery Stent Placement

Journal of Endovascular Therapy ◽

10.1177/152660280200900419 ◽

2002 ◽

Vol 9 (4) ◽

pp. 495-502 ◽

Cited By ~ 6

Author(s):

Trude C. Gill-Leertouwer ◽

Elma J. Gussenhoven ◽

Johanna L. Bosch ◽

Jaap Deinum ◽

Hans van Overhagen ◽

...

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Stent Placement ◽

Clinical Success ◽

Artery Stenosis ◽

Renal Function Impairment ◽

Function Impairment ◽

Renal Artery Stent

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.

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