Distal embolic protection during renal artery angioplasty and stenting.
BACKGROUND
Percutaneous renal artery angioplasty and/or stenting (RA-PTAS) is increasingly being used as an alternative to surgery for renal artery revascularization. Unfortunately, renal function responses after RA-PTAS appear to be inferior to those observed after surgical revascularization both in terms of improving and preventing deterioration of renal function postintervention. Atheroembolism during RA-PTAS has been postulated as a potential cause for the disparate results. Strategies to limit the occurrence of atheroembolism, such as the use of distal embolic protection (DEP) systems, may result in improved outcomes after RA-PTAS.


METHODS
All RA-PTAS procedures performed with DEP (using a commercially available temporary balloon occlusion and aspiration catheter) between October 2003 and July 2005 were reviewed. Glomerular filtration rate (eGFR) was estimated preintervention and 4 to 6 weeks postintervention using the abbreviated Modification of Diet in Renal Disease formula. Renal function and hypertension response rates as well as procedural data were classified and reported according to American Heart Association guidelines. Renal function improvement and deterioration were defined as a 20% increase and decrease in eGFR, respectively, compared with preoperative values. Continuous and categoric data were analyzed using paired t tests and repeated measures linear models.


RESULTS
DEP was used in 32 RA-PTAS procedures in 15 women and 11 men with a mean age of 71 years. All patients were hypertensive, 24 (92%) had renal insufficiency, and the mean preintervention degree of renal artery stenosis was 79%. Immediate technical success was achieved in 100% of RA-PTAS cases. Mean pre- and postintervention serum creatinine and eGFR values were 1.9 vs 1.6 mg/dL (P < .001) and 37 vs 43 mL/min/1.73 m(2) (P < .001), respectively. Renal function was defined as improved after 17 (53%) of 32 procedures and worsened in none (0%).


CONCLUSIONS
RA-PTAS using DEP resulted in 4- to 6-week postintervention renal function results approximating those of surgical revascularization. These data suggest that DEP use may prevent renal function harm during RA-PTAS as a result of atheroembolism and warrant further investigation.
Edwards
Matthew S
MS
Department of General Surgery, Section on Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. medwards@wfubmc.edu
Craven
Brandon L
BL
Stafford
Jeanette
J
Craven
Timothy E
TE
Sauve
Kenneth J
KJ
Ayerdi
Juan
J
Geary
Randolph L
RL
Hansen
Kimberley J
KJ
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects; D050197:Atherosclerosis / Q000601:surgery*; D021721:Balloon Occlusion / Q000379:methods*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000601:surgery*; D015607:Stents; D014654:Vascular Patency
D003404:Creatinine