A12974 The Clinical Outcomes of Renal Stenting Combined with Optimal Medical Therapy in Patients with Severe Atherosclerotic Renal Artery Stenosis

Abstract

Objectives: To analyze the clinical outcomes of renal artery stenting combined with optimal medical therapy as treatment for atherosclerotic renal artery stenosis (ARAS) Methods: We retrospectively analyzed the data from consecutive patients with ARAS (diameter reduction≥70%), who underwent percutaneous renal stenting in Fuwai Hospital between Jan 1999 and Jan 2016 because of severe hypertension(sustained SBP≥160mmHg and/or DBP≥100mmHg) or preservation of renal function. The patients received optimal medical therapy and were followed up once a year. The clinical outcomes, including office blood pressure (OBP), 24-h ABP, number of antihypertensive medications, eGFR and composites of primary endpoints (myocardial infarction, stroke, renal failure and cardiovascular death), were recorded. Results: Totally,1325 patients were enrolled in the study, with mean age 62.8 ± 9.4 (38–84) yr and male 72.5%. The technique success rate of procedure was 99.5%. mean stenosis was reduced from 82.5 ± 6.9% to 9.5 ± 7.2% with 30-day perioperative complication rate 1.8% and mortality0.15%. Mean follow-up was 4.5 ± 4.2year. At 12 months after the procedure, both OBP and 24-h ABP significantly decreased (OBP 151.2/85.8 Vs132.8/74.6mmHg and 24h-ABP 142.8/79.4 Vs 128.6/ 71.5mmHg, respectively; P < 0.01), less antihypertensive medication was taken (2.5 ± 1.1 Vs 1.6 ± 0.8,P < 0.01), and eGFR increased significantly (80.2 ± 26.5Vs 72.4 ± 25.3 ml/min. 1.73 m 2, P < 0.05). The survival rate of free from composites of primary endpoints was 97.3%, 94.2%, 90.5%, 85.4%, 80.7%, 74.6%, 56.2%, 42.3% at 1,2,4,6,8,10,12,14 years. Conclusion: Renal stenting combined with optimal medical therapy as a treatment has a beneficial effect on blood pressure, renal function and cardiovascular events in selected patients with ARAS. The findings should be further investigated.