HDCN Article Review/Hyperlink

Blum U, Krumme B, Flugel P, Gabelmann A, Lehnert T, Buitrago- Tellez C, Schollmeyer P, Langer M

Treatment of ostial renal artery stenoses with vascular endoprostheses after unsuccessful balloon angioplasty

New Engl J Med (Feb) 349:459-465 1997

The authors (Interventional Radiologists) present a series of 68 patients with renovascular hypertension in whom 74 ostial renal artery stenoses were treated with short (1-1.5 cm) Palmaz stents. This patient population is a subset of 75 patients in whom 82 arteries were treated with balloon angioplasty; stent placement was used to treat suboptimal angioplasty results. The high percentage of patients requiring stents is typical of the results of angioplasty alone in ostial lesions. The authors used color doppler follow-up at regular intervals as well as arteriographic follow-up at 12 and 24 months.

Technical success in lesion treatment was achieved in 100% of patients, usually with a single stent. Complications were limited to 3 groin hematomas which required no further treatment. During surveillance with ultrasound and arteriography, restenosis was discovered in eight stents, six of which were treated with repeat dilation and stent placement. This yields a 5 year primary patency projected by life table analysis of 84.5% and secondary patency of 92.4% (48 arteries were studied at one year and 28 at two years with arteriography).

Clinical success in reversing hypertension was achieved in16% of patients; hypertension was improved in 62% and unchanged in the remainder. Serum creatinine values remained stable after the procedure, an important consideration given the trend for progression of renal insufficiency in this population.

The excellent short- and long-term results reported in this series indicate that stents are a powerful tool in treating ostial renal artery stenosis, and that restenosis in these stents may not be as significant as previously thought. Since these results compare extremely favorably to those of surgical bypass, a randomized clinical trial between the two modalities would seem warranted. (Scott Trerotola, M.D., Indiana University, Indianapolis)

The abstract of this paper is available from the National Library of Medicine's PubMed site: click here .