Hemodynamic index of atheromatous renal artery stenosis for angioplasty.
OBJECTIVE
Trans-stenotic pressure gradient across the constriction (PG), a hemodynamic variable of atheromatous renal artery stenosis (ARAS), is a widely used indicator for angioplasty, but its association with the outcome of angioplasty has not been fully investigated.


METHODS
In 34 hypertensive cases with unilateral ARAS, we evaluated hemodymanic variables of ARAS with reference to the systemic BP reduction after angioplasty as the outcome.


RESULTS
In each phase, PG divided by its corresponding prestenotic arterial BP (PG/preBP) had better association with the outcome than PG. The mean phase PG/preBP had the largest area under the curve in the receiver operating characteristic analysis (0.794) with the sensitivity/specificity of 0.957/0.545 for its cut-off >0.15. Although the plasma renin activity, which reflects the perfusion to renal parenchyma, was higher in the angioplasty-efficacious cases than in the angioplasty-inefficacious cases before angioplasty (7.8 +/- 6.6 versus 3.4 +/- 3.8 ng/ml/h, P = 0.049), it was not generally reduced by angioplasty independent of the outcome.


CONCLUSIONS
As the index to select ARAS for angioplasty, PG/preBP was better than PG and the mean phase PG/preBP could be the best. However, other factors such as the microvascular kidney disease, which affect the perfusion to renal parenchyma, would influence the outcome.
Tanemoto
Masayuki
M
Department of Medicine, Division of Nephrology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. mtanemoto-tky@umin.ac.jp
Suzuki
Takehiro
T
Abe
Michiaki
M
Abe
Takaaki
T
Ito
Sadayoshi
S
D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D050197:Atherosclerosis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006978:Hypertension, Renovascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012078:Renal Artery Obstruction / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012079:Renal Circulation; D012083:Renin / Q000097:blood; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome
D003404:Creatinine; D012083:Renin