Long-term outcomes and determinants of stenosis recurrence after renal artery angioplasty in hypertensive patients with renovascular disease.

Abstract

IntroductionRestenosis (RS) following percutaneous angioplasty (PTA) of renal artery stenosis (RAS) might have an unfavourable impact on renal function and blood pressure (BP) outcomes.AimTo evaluate the prevalence and predictors of RS in patients treated with PTA for RAS, and the relationship between BP and renal function (RF) changes with RS.Material and methodsWe analysed freedom from RS in 210 patients (age 64.6 ±12.8 years; range: 20–85), who underwent 248 successful stent-assisted PTAs in RAS. The change in levels of serum creatinine (SCC), estimated glomerular filtration rate (eGFR), systolic/diastolic BPs (SBP/DBP) were analysed prior to PTA, at 6-, 12-month, and final follow-up visits, and whenever RS was diagnosed.ResultsRS was identified in 30 (14.3%) patients, and there were 36 (14.5%) lesions. The Kaplan-Meier RS-free survival curves in fibromuscular dysplasia, atherosclerosis, and vasculitis at 1 and 7 years were: 100% and 100%; 95.6 and 83.9%; and 71.4 and 39.7%, respectively. Patients with RS, as compared to RS-free patients, presented with less pronounced changes in respect with: SBP (1.4 ±17.6 vs. −15.8 ±25.8 mm Hg; p = 0.01), DBP (2.64 ±10.1 vs. −6.5 ±14.1 mm Hg; p = 0.002), SCC (22.4 ±55.2 vs. −3.6 ±43.9 µmol/l; p = 0.002), and eGFR (–1.85 ±18 vs. −5.34 ±19.5 mm Hg; p = 0.045). In multivariate Cox regression analysis, independent predictors of RS occurred: lack of BP decrease (HR = 4.19, 95% CI: 1.67–10.3; p = 0.002), eGFR increase < 0.17 ml/min/1.73 m2 (HR = 2.93, 95% CI: 1.08–7.91; p = 0.033), stent diameter ≤ 5 mm (HR = 2.76, 95% CI: 1.09–6.97; p = 0.031), and vasculitis (HR = 5.61, 95% CI: 1.83–17.2; p = 0.003). RS was treated in 24 patients with RS recurrence in 20%.ConclusionsThe RS rate differs depending on RAS aetiology. Lack of SBP/DBP and eGFR improvement, vasculitis, and stent diameter are associated with RS risk. Repeated PTA is effective, but recurrent RS occurs in 20% of cases.