#1047 Duration of dual antiplatelet therapy after stent placement in renal artery stenosis

Abstract

Abstract Background and Aims Renovascular hypertension (RVH) is currently considered one of the most prevalent and important causes of secondary hypertension and renal organ damage. The prevalence of RVH in hypertensive patients increases more than 40% in elderly, comorbid and atherosclerotic patients. Although controlled trials in patients with Atherosclerotic Renovascular Disease (ARVD) have not been conclusive about the superiority of Percutaneous Revascularization (PR) over optimal medical treatments, this procedure is still indicated in selected patients, however the optimal duration of dual antiplatelet therapy after PR to avoid stent restenosis has not been well described. Method Retrospective study including 51 patients (median age 66.8 years IR: 48.7-87.6; male 35.3%) with resistant hypertension. All patients were diagnosed of Atherosclerotic renovascular hypertension (ARVH) through angioTC and renal arteriography (≥50% stenosis). All of them underwent PR by angioplasty plus stent placement. Patients were stratified into two groups according to dual antiplatelet therapy duration (with Aspirin 100 mg and Clopidrogrel 75 mg). Group I: Dual antiplatelet therapy for 3 months (n = 14) and Group II: Dual antiplatelet therapy for 6 months (n = 37). All patients continued with single antiplatelet therapy at the end of the dual antiplatelet period and were followed during a mean of 4.5 ± 3.8 years. Clinical, analytical and demographic data were collected, as well as cardiovascular risk factors and number of antihypertensive drugs. Besides, blood pressure and kidney function were measured before and after the procedure. Results During the follow up, stent restenosis occurred in thirteen patients (25.5%), (group I: 6 (46.2%), group II: 7 (53.8%), p = 0.080). No differences in blood pressure between two groups were observed (SBP/DBP before and after PR (group I: 175.3/94.7 mmHg and 122.5/71.9 mmHg and group II: 181.1/94.5 mmHg and 125.0/75.5 mmHg, p = N/S)). The number of antihypertensive drugs was similar between two groups before and after the procedure (Group I: 4.6 ± 2.2 and 3.4 ± 1.3; Group II 4.8 ± 1.4 and 3.5 ± 1.7, p = N/S). There was an improvement in blood pressure control in both groups after PR (SBP/DBP 179.5/94.5 mmHg to 124.9/74.9 mmHg, p = 0.000) and this reduction persisted one year after treatment SBP/DBP 139.2/78.0 mmHg, (p = 0.001). In addition, a reduction in antihypertensive drugs were observed in both groups (4.8 vs 3.5 p = 0.000). Stable renal function was observed previously and two years after treatment. In multivariate analysis, risk factors associated to stent restenosis were LDL (1.0 CI: 1.0- 1. 05; p = 0.034) and triglycerides (1.0 CI 1.0- 1.1; p 0.038) at 6 month post-stent placement. Conclusion