Renal artery stenting in patients with chronic ischemic heart disease.
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.
Trani
Carlo
C
Department of Cardiology, Catholic University of the Sacred Heart, Viale G. Rossini 74, Rome, Italy. carlotrani@rm.unicatt.it
Tommasino
Antonella
A
Giammarinaro
Maura
M
Burzotta
Francesco
F
Coroleu
Santiago Federico
SF
Rufini
Vittoria
V
Mazzari
Mario Attilio
MA
Porto
Italo
I
Niccoli
Giampaolo
G
Leone
Antonio Maria
AM
Mongiardo
Rocco
R
Gabrielli
Francesca Augusta
FA
Schiavoni
Giovanni
G
Biamino
Giancarlo
G
Crea
Filippo
F
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
D000959:Antihypertensive Agents; D015415:Biomarkers; D003404:Creatinine