Clinical and angiographic predictors of restenosis following renal artery stenting.
Percutaneous stenting has become the procedure of choice for treatment of obstructive atherosclerotic renal artery (RA) disease. Restenosis, however, continues to be in the range of 15-25% of treated vessels. In this study, clinical and angiographic predictors of restenosis were assessed. Of 132 vessels included, fifty-eight were followed for restenosis using duplex Doppler (n=15), conventional angiogram (n=33) or multislice computed tomography (CT) angiogram (n=10). Fifteen vessels (26%) met the criteria for restenosis (lesion > or =50% by conventional or CT angiography or >60% by Doppler) at a follow-up range of 2-20 months (5% <2 months; 68% 3-12 months; 27% 13-20 months). Cox Regression analyses were performed for selected variables. A p-value <0.05 was considered statistically significant. History of smoking [odds ratio (OR), 6.6:1; p=0.005] and time to evaluate for restenosis were independent predictors of the occurrence of restenosis. Also, a high restenosis rate (40%) was seen in vessels < or =4 mm in diameter (n=20) in contrast to larger vessels (n=38) >4 mm (18.4%). Although statistical significance was not reached (possibly because of the small sample size), clinically this is a significant finding. A significant drop in systolic (-15.6 mmHg) and diastolic (-6.2 mmHg) blood pressures was seen following RA stenting with no significant change in the total number of antihypertensives used (2.4 versus 2.5 for pre- and post-renal stenting, respectively).


CONCLUSIONS
Restenosis occurred in 26% of successfully stented RAs. History of smoking, time to evaluate for restenosis and small vessels (< or =4 mm) were predictors of its occurrence. Clinically, a significant drop in blood pressure was seen with RA stenting without a change in the total number of antihypertensives on follow-up.
Shammas
Nicolas W
NW
Genesis Heart Institute, Cardiovascular Medicine, PC, St. Ambrose University, Davenport, IA 52803, USA. shammas@mchsi.com
Kapalis
Matthew J
MJ
Dippel
Eric J
EJ
Jerin
Michael J
MJ
Lemke
Jon H
JH
Patel
Pragnesh
P
Harris
Melodee
M
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler