Balloon angioplasty or stent placement in patients with azotemic renovascular disease: a retrospective comparison of clinical outcomes.
In this study comparing functional outcomes of renal angioplasty alone (PTRA) or angioplasty with stent placement in patients with renal artery stenosis (> or =60%) and renal insufficiency, 69 patients were treated with PTRA or stent placement. After censoring, the PTRA group included 15 patients with a mean age of 75 years, mean serum creatinine (Cr) of 2.9 +/- 1.4 mg/dL, and mean follow-up of 10 months. The stent placement group included 40 patients with a mean age of 71 years, mean Cr of 2.6 +/- 1.2 mg/dL, and mean follow-up of 12 months. Stenting was performed primarily in four cases and after suboptimal angioplasty in the remainder. Benefit was defined as either stabilization (+/-20%) or improvement in serum Cr levels. Technical success was achieved in 16 of 17 (94%) PTRA patients and 55 of 58 (95%) patients receiving stents. Complications included one surgically repaired axillary pseudoaneurysm, one distal stent positioning requiring a second stent, one stent protruding 5 mm into the aorta, two dissections requiring additional stents, one retroperitoneal hematoma, and one intrarenal atheroembolism treated with thrombolysis. Three patients (mean initial Cr 3.9 mg/dL) required hemodialysis within 30 days of stenting. One patient discontinued dialysis after stenting. There were two procedure-related deaths. An overall benefit was seen in 40% of patients after PTRA and 66% of patients after stent placement. For the stent placement and PTRA groups, cumulative clinical benefit was 77% and 80%, respectively, at 3 months; 69% and 64%, respectively, at 6 months; 61% and 41%, respectively, at 12 months; and 48% and 14%, respectively, at 24 months. A 50% loss of cumulative benefit was seen 34 months after stenting and 11.5 months after PTRA. In the stent and PTRA groups, benefit was noted in 77% and 57%, respectively, of patients with an initial Cr of 2.3 or less, 53% and 25%, respectively, of patients with an initial Cr level higher than 2.3, and 44% and 17%, respectively, of patients with an initial Cr level of 3.0 mg/dL or more. For patients with renal insufficiency, renal artery stenting provides superior clinical results compared with PTRA, mostly because late deterioration occurs after PTRA. Outcomes are related to pretreatment serum Cr level.
Rundback
J H
JH
New York Medical College, Westchester Medical Center, Valhalla, New York 10595, USA.
Manoni
T
T
Rozenblit
G N
GN
Poplausky
M
M
Maddineni
S
S
Crea
G
G
Matalon
T A
TA
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000800:Angioplasty, Balloon / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000601:surgery*; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
D003404:Creatinine