Angiographic and intravascular ultrasound assessment of immediate and 9-month efficacy of percutaneous transluminal renal artery balloon angioplasty with subsequent brachytherapy in patients with renovascular hypertension.
OBJECTIVE
Scarce data exist concerning the long-term effect of renal balloon angioplasty (PTRA) enhanced by intravascular gamma-brachytherapy (IVBT) in patients with renovascular hypertension. The aim of this randomized study was to evaluate long-term outcome after PTRA with IVBT in patients with renal artery stenosis.


METHODS
71 patients with renovascular hypertension were randomized into group I (PTRA + IVBT) or group II (PTRA). 9 patients who required stent implantation were excluded. Both baseline and 9-month follow-up quantitative computerized angiography and intravascular ultrasound (IVUS) analysis were performed to assess restenosis. During the 9-month follow-up, 3 patients died - 2 from group I and 1 from group II.


RESULTS
The restenosis rate was 16.1% in group I and 32.1% in group II. The 9-month lumen loss in angiography was 1.2 +/- 0.7 and 1.7 +/- 0.7 mm (p = 0.004) and the area loss (IVUS) was 6.5 +/- 4.8 and 10.1 +/- 5.6 mm(2) in groups I and II, respectively (p = 0.01). eGFR increased both in group I (from 75 +/- 22 to 84 +/- 31 ml/min/1.73 m(2); p < 0.001) and in group II (from 74 +/- 23 to 77 +/- 23 ml/min/1.73 m(2); p = 0.04). Only the diastolic blood pressure in group I decreased significantly (65 +/- 17 and 77 +/- 18 mm Hg; p = 0.048). The rate of blood pressure normalization was low in both groups (6.1 and 6.9%).


CONCLUSIONS
IVBT after PTRA with a self-centering source is a safe and effective method for prevention of restenosis in patients with renovascular hypertension.
Lekston
Andrzej
A
Third Department of Cardiology, Silesian Center for Heart Disease, Zabrze, Poland. marosu22@wp.pl
Chudek
Jerzy
J
Gasior
Mariusz
M
Wilczek
Krzysztof
K
Wiecek
Andrzej
A
Kokot
Franciszek
F
Gierlotka
Marek
M
Niklewski
Tomasz
T
Fijałkowski
Marek
M
Szyguła-Jurkiewicz
Bozena
B
Wojnicz
Roman
R
Białas
Brygida
B
Osuch
Marcin
M
Maciejewski
Bogusław
B
Poloński
Lech
L
D000328:Adult; D000792:Angiography; D000800:Angioplasty, Balloon; D001794:Blood Pressure; D001918:Brachytherapy; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000517:prevention & control*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional