Restenosis after stenting of atherosclerotic renal artery stenosis: is there a rationale for the use of drug-eluting stents?
Percutaneous stent-angioplasty has become an accepted therapy for the treatment of atherosclerotic renal artery stenosis (RAS) because of higher acute and long-term success rates compared with balloon angioplasty alone. Restenosis rates after successful renal stent placement vary from 6 to 20% and depend mainly on the definition of restenosis and the vessel diameter of the renal artery or stent. We recommend that restenosis should be defined as >70%. The safety and efficacy of drug-eluting stents for the treatment of RAS is poorly defined. The currently partially published GREAT study (Palmaz Genesis peripheral stainless steel balloon expandable stent: comparing a sirolimus-coated vs. a bare stent in REnal Artery Treatment) examined the effect of a sirolimus-coated stent on restenosis rate in 102 patients and found a relative risk reduction of angiographic binary in-stent restenosis by 50% (7% versus 14%, P = ns). Given the lack of outcome data, the considerable expenses associated with drug-eluting stents, morbidity, and cost associated with prolonged dual antithrombotic therapy, the use of drug-eluting stents in RAS should be restricted to clinical trials. This is a review on restenosis rate following renal stenting, its definition, and the potential use for implantation of a drug-eluting stent in RAS, which so far for this indication is not yet commercially available.
Zeller
Thomas
T
Department of Angiology, Heart Centre Bad Krozingen, Bad Krozingen, Germany. thomas.zeller@herzzentrum.de
Rastan
Aljoscha
A
Rothenpieler
Uwe
U
Müller
Christian
C
D000800:Angioplasty, Balloon; D050197:Atherosclerosis / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D016503:Drug Delivery Systems; D019983:Guideline Adherence; D006801:Humans; D018810:Magnetic Resonance Angiography; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency