Renal Stenting for Incidentally Discovered Renal Artery Stenosis: Is There Any Outcome Benefit?

Abstract

Conclusion: Stenting of incidentally discovered renal artery stenoses at the time of an angiogram performed for another indicated procedure results in minimal benefit compared with medical management alone. Summary: Significant renal artery stenosis is frequently encountered at the time of angiography performed for other forms of arterial disease. The authors performed a retrospective medical record review of patients undergoing renal arteriography during 4 years. They used catheterization reports to identify patient diagnosed with high-grade renal artery stenosis (>70%). Patients treated with renal artery angioplasty were identified, and baseline and postprocedural blood pressure, glomerular filtration rate, serum creatinine, and antihypertensive medication regimens were compared after 12 months of follow-up. During the 4-year period, 124 patients underwent renal arteriography with 78 (63%) diagnosed with high-grade renal artery stenosis. Renal artery stents were placed in 58 patients (74%). When compared with the patients with high-grade renal artery stenosis who received no intervention, the patients with renal artery stents had similar baseline characteristics with the exception of lower diastolic blood pressure (74 ± 11.2 vs 80 ± 14.2 mm Hg, P = .04) and a higher proportion of increased lipids (78% vs 55%, P = .05). Follow-up was available in 58 of the renal artery stented patients (66%). Postprocedural variables in patients with renal artery stents with 12-month follow-up indicated there was reduction in systolic blood pressure (153 ± 20.8 vs 136 ± 27.2, P = .01) and mean arterial pressure (103 ± 11.2 vs 95 ± 14 mm Hg, P = .04). Significant reductions in systolic mean arterial and diastolic blood pressure were, however, only noted in the patients who also had an increase in the number of antihypertensive medications. There were no differences in renal insufficiency detected. Comment: This is a retrospective study with incomplete data. Nevertheless, it is certainly not a testimonial to the efficacy of renal artery stents in patients with unsuspected renal artery stenosis. The only parameter that improved in the stented patients was blood pressure, and that only improved if there was an increase in antihypertensive medications. The data do not support routine practice of renal angioplasty and stenting for incidentally discovered lesions. Clearly, the management of incidentally discovered renal artery stenosis remains controversial.