Intravascular stents in the treatment of renal artery stenosis (RAS).
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:324A 1997
Intravascular stent placement into the renal artery provides endovascular mechanical support against stenosis. For the treatment of renal artery stenosis (RAS) involving the ostium, the success rate of the traditional percutaneous transluminal angioplasty (PTA) rarely exceeds 20 -25%. Such lesions appear to be particularly amenable to stent placement..
The authors report their 5-year experience on 129 patients (63 males, 66 females) with ostial RAS who were treated with intravascular (Palmaz) stent placement. The mean age of the patients was 71 ±10 y., 98% had hypertension and 54% showed renal impairment. 78% of the cases was unilateral, 15% bilateral and 7% of the patients had single kidney. The immediate success of the procedure was 98% with 14% restenosis rate at 8±5 mo. At 24 mo following the procedure, the systolic and diastolic BP were significantly reduced from 158±3 and 84±1 to 135±3 and 79±2, respectively. Over the 2-year follow-up period, the renal function remained stable as estimated by the Cockroft-Gault creatinine clearance. These data compare favorably with the outcome of PTA.
Comment: The rate of acute complications (groin hematoma, iliac artery dissection, renal infarction and renal failure due to the contrast material or cholesterol emboli) appear to be higher after stent placement than following PTA. These data are not available in the abstract but undoubtedly will be reported in a full communication. The restenosis rate in this study is lower than in previous series (14% at 8 months vs. 20-38% at 1 year). It could be due to a somewhat shorter follow-up or improving techniques. This study underlines that stent placement for the treatment of ostial renal artery stenosis is not just an evolving modality but a viable alternative to PTA. (Laszlo Hopp, Alfred I. duPont Hospital for Children; Wilmington, DE)
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ASN 30th Annual Meeting, San Antonio
H: Special problems : Renovascular hypertension