Repeated intervention for in-stent restenosis of the renal arteries.
OBJECTIVE
To assess the long-term technical success of repeated endovascular intervention in stenosed renal artery stents.


METHODS
Fifteen patients with stenoses >or=50% in a renal stent placed because of an ostial atherosclerotic renal artery stenosis were included in this study. In the presence of increased blood pressure or decreased renal function, the in-stent restenosis was treated with percutaneous transluminal angioplasty (PTA) in the stent or placement of a second stent if the stenosis was located too distally in the stent. The results of these repeat interventions were evaluated by angiography.


RESULTS
The 15 patients had a total of 20 stenosed stents. Eighteen of these in-stent stenoses were treated with PTA and two were treated with placement of a second stent. Angiographic follow-up was available in 16 arteries, showing in-stent restenosis in four (25%; mean follow-up, 11 mo). The cumulative patency rates after repeat endoluminal intervention were 93% (95% CI: 80%-106%) and 76% (95% CI: 52%-101%) after 6 and 12 months, respectively. Renal function remained stable or improved in most patients (80%) after repeated intervention in the stent, and hypertension was classified as improved or cured in 47% of patients after 1 year.


CONCLUSIONS
Patients with stenosed renal artery stents can be treated successfully with PTA in a majority of cases, with a long-term success rate of 75% and stable renal function 1 year after repeated intervention.
Bax
Liesbeth
L
Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Mali
Willem P Th M
WP
Van De Ven
Peter J G
PJ
Beek
Frederik J A
FJ
Vos
Jan Albert
JA
Beutler
Jaap J
JJ
D000800:Angioplasty, Balloon; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency