Screening, diagnosis, and treatment of renal artery stenosis by percutaneous transluminal renal angioplasty with stenting.
BACKGROUND
Renal artery stenosis is one of the most frequent causes of secondary hypertension. Appropriate methods for screening, diagnosis and therapy are currently under debate.


OBJECTIVE
To evaluate and recommend methods for screening and diagnosing renal artery stenosis, and to assess the clinical outcomes of renal artery stenting.


METHODS
A total of 450 patients undergoing non-emergent coronary angiography fulfilled the selection criteria for selective renal arteriography; those with severe (luminal narrowing > or = 70%) renal artery stenosis underwent percutaneous transluminal renal angioplasty with renal artery stenting.


RESULTS
Of 166 patients (36.9%) with renal artery stenosis, 41 (9.1%) had severe stenosis that required renal artery stenting, and 83% had ostial renal stenosis. The primary success rate was 100% and there were no complications. During the follow-up period, two patients required a second PTRA. After stent deployment, significant reductions were observed in systolic and diastolic pressures (P < 0.001 and P = 0.01, respectively) and in the number of antihypertensive drugs used by the patients (P < 0.001). These reductions were sustained during follow-up. Hypertension was cured (systolic blood pressure < 130 mmHg) in 9 patients (21.4%) and improved in 27 (64.3%). Plasma creatinine did not change significantly.


CONCLUSIONS
Selective renal angiography is an effective diagnostic tool for identifying symptomatic cases of renal artery stenosis in patients undergoing coronary angiography. Our finding of a high success rate and low complication rate supports the use of primary renal artery stenting in symptomatic patients with renal artery stenosis.
Kobo
Ofer
O
Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel.
Hammoud
Mahmod
M
Makhoul
Nabeel
N
Omary
Hatem
H
Rosenschein
Uri
U
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000150:complications; D001794:Blood Pressure / Q000502:physiology; D003287:Contrast Media; D017023:Coronary Angiography; D003404:Creatinine / Q000097:blood; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018579:Patient Selection; D012078:Renal Artery Obstruction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D019233:Retreatment; D015607:Stents; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D003287:Contrast Media; D003404:Creatinine