title: Clinical effectiveness of secondary interventions for restenosis after renal artery stenting.
abstract: OBJECTIVE
  Secondary interventions for renal artery restenosis (RAS) after renal artery stenting are common, despite limited data about their effectiveness. This study was designed to evaluate the outcomes of endovascular treatment of recurrent RAS.
  
  
  METHODS
  We conducted a retrospective review of patients who underwent renal artery stenting between 2001 and 2011 at Dartmouth-Hitchcock Medical Center. Patients who required secondary interventions were compared with control patients who underwent only primary interventions for RAS. Multivariate regression models were used to identify factors associated with successful outcomes, as measured by changes in blood pressure, estimated glomerular filtration rate, and number of antihypertensive medications required.
  
  
  RESULTS
  Sixty-five secondary (57 patients) renal interventions were undertaken for recurrent RAS associated with progressive hypertension or renal dysfunction and compared with outcomes after 216 primary (180 patients) renal artery stenting procedures. Patients undergoing primary vs secondary interventions did not differ significantly in the number of preoperative antihypertensive medications used, comorbid conditions, or blood pressure. All primary and secondary interventions were performed with stents and showed no difference in procedural complications. At a mean follow-up of 23 months (range, 1-128 months), similar improvements in renal function and blood pressure were found between patients undergoing primary and secondary interventions, and there was no difference in rates of restenosis or survival between cohorts. Regression models showed that the use of embolic protection devices was associated with improved renal function after primary (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.8; P < .05) and secondary (OR, 4.7; 95% CI, 1.7-12.5; P < .05) interventions, whereas statin therapy was associated with improved renal (OR, 2.0; 95% CI, 1.3-3.2; P < .05) and blood pressure response (OR, 4.1; 95% CI, 1.1-14.9; P < .05) after secondary interventions.
  
  
  CONCLUSIONS
  Patients undergoing secondary interventions for recurrent RAS have outcomes that are comparable with those for primary interventions. These data suggest that repeated endovascular procedures for RAS can be undertaken with similar expectations for clinical improvement and may be further improved by routine use of embolic protection devices and statin therapy.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Simone
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
authors.forename: David H
authors.initials: DH
authors.lastname: Stone
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Powell
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
authors.forename: Brian W
authors.initials: BW
authors.lastname: Nolan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D057505:Embolic Protection Devices; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006978:Hypertension, Renovascular / Q000503:physiopathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009513:New Hampshire; D016017:Odds Ratio; D020127:Recovery of Function; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors