title: Renal artery stenting in patients with chronic ischemic heart disease.
abstract: OBJECTIVE
  To investigate the role of renal stenting in selected patients with chronic ischemic heart disease and renal artery stenosis.
  
  
  METHODS
  Consecutive patients, with chronic ischemic heart disease and severe hypertension and/or impaired renal function undergoing renal stenting, were prospectively enrolled. Mid-term (at least 2 years) follow-up was performed to assess both changes in renal function [serum creatinine and estimated glomerular filtrate rate (eGFR)] and blood pressure (BP) control (number of required drugs) and to record the incidence of clinical major adverse events. Moreover, in the first consecutive 24 patients, out-of-range pressure values at 24-hr BP monitoring and GFR at renal scintigraphy were measured at baseline and 1 month after stenting.
  
  
  RESULTS
  Seventy patients treated by stenting on 86 renal arteries entered the study. Procedural success rate was 99% and no major complication occurred. At 2-year follow-up, both mean serum creatinine (-0.1 +/- 0.7 mg/dl at follow-up compared to baseline, P = 0.6) and eGFR (+3.7 +/- 23.5 ml/min/1.73m(2) at follow-up compared to baseline, P = 0.2) did not significantly change while the number of drugs required to control BP significantly decreased (2.7 +/- 0.8 to 2.2 +/- 0.7, P < 0.0001). In the subset of 24 patients evaluated at 1 month, GFR significantly increased (62 +/- 20 ml/min to 67 +/- 21 ml/min; P = 0.008) and the rate of the out-of-range systolic pressure values at 24-hr monitoring significantly decreased (51-33%, P = 0.005). Elevated baseline creatinine values and the presence of global renal ischemia were identified as predictors of poor outcome at the multivariate analysis.
  
  
  CONCLUSIONS
  In selected patients with chronic ischemic heart disease and hypertension and/or renal insufficiency, renal stenting may be performed with very low periprocedural complications and results in unchanged renal function and improved BP control.
authors.affiliation: Department of Cardiology, Catholic University of the Sacred Heart, Viale G. Rossini 74, Rome, Italy. carlotrani@rm.unicatt.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Antonella
authors.initials: A
authors.lastname: Tommasino
authors.forename: Maura
authors.initials: M
authors.lastname: Giammarinaro
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Santiago Federico
authors.initials: SF
authors.lastname: Coroleu
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rufini
authors.forename: Mario Attilio
authors.initials: MA
authors.lastname: Mazzari
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Rocco
authors.initials: R
authors.lastname: Mongiardo
authors.forename: Francesca Augusta
authors.initials: FA
authors.lastname: Gabrielli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Schiavoni
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Biamino
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006978:Hypertension, Renovascular / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D003404:Creatinine