Clinical and Renal Cortical Blood Perfusion Characteristics in Patients with Severe Atherosclerotic Renal Artery Stenosis Who Underwent Stent Implantation: A Single-center Retrospective Cohort Study

Abstract

Abstract Objective This study aimed to observe the clinical imaging features of patients with severe atherosclerotic renal artery stenosis (ARAS) receiving stent implantation, and to evaluate the associations between baseline clinical and imaging factors and renal-function deterioration at a 1-year follow-up. Methods This study was a single-center retrospective cohort study. A total of 159 patients with unilateral severe ARAS who underwent stent implantation at Beijing Hospital between July 2017 and December 2020 were consecutively enrolled. According to the renal glomerular filtration rate (GFR), detected by radionuclide renal imaging at 1-year follow-up, all patients were divided into a poor-prognosis group (with a ≥30% decrease in renal GFR; n=32 cases) and a control group (127 cases). Clinical imaging data, including the renal cortical blood perfusion pre- and post-sent implantation, were analyzed. Univariate and multivariate logistic regression analysis was used to evaluate the associations between clinical and imaging factors and renal-function deterioration. Results Of the 159 patients enrolled, 83 (52.2%) were men, with an average age of (57.2±14.7) years. The patient age, rate of diabetes, and systolic blood and diastolic blood pressure in the poor-prognosis group were significantly higher than those in the control group (all P<0.05). Before stent treatment, patients in the poor-prognosis group, compared with the control group, had a significantly smaller area under the ascending curve (AUC1), area under the descending curve (AUC2), and peak intensity (PI), and a longer time to peak intensity (TTP) and mean transit time (MTT) (all P<0.05). After stent treatment, patients in the poor-prognosis group, compared with the control group, showed significantly smaller AUC1, AUC2, and PI, and longer MTT (all P<0.05). Multivariate logistic regression analysis indicated that age (OR=1.251, 95%CI: 1.113–1.406, P=0.0002), diabetes (OR=1.472, 95%CI: 1.110–1.952, P=0.007), systolic blood pressure (OR=1.339, 95%CI: 1.082–1.657, P=0.007), renal GFR (OR=2.025, 95%CI: 1.217–3.369, P=0.006), and AUC1 post-stent (OR=2.173, 95%CI: 1.148–4.113, P=0.017) were the factors associated with renal deterioration at the 1-year follow-up. Conclusions Patients with severe RAS with renal-function deterioration after stent implantation were older, and often had diabetes, hypertension, and impaired renal cortical perfusion. Age, diabetes, systolic blood pressure, renal GFR, and AUC1 after stent implantation were independent factors associated with short-term renal deterioration.