Treatment of renal angioplasty failure by percutaneous renal artery stenting with Palmaz stents: midterm technical and clinical results.

Abstract

Renal artery stenting has recently been used to treat failures or complications of renal angioplasty. Although technical results and complication rates have been reported, clinical follow-up and long-term data are limited. The purpose of this study was to evaluate the midterm clinical efficacy and safety of Palmaz stents in rescuing renal artery angioplasty failures. Palmaz stents were placed in 35 renal arteries of 33 patients (14 men and 19 women; 37-77 years old; mean age, 62.6 years old) for immediate angioplasty failure (29 arteries) or for recurrent stenosis after previous angioplasty (six arteries). Indications for treatment were hypertension alone (16 patients) or hypertension associated with renal failure (17 patients). Blood pressure, medication, and serum creatinine level were followed after stenting. No residual stenosis was found immediately after stenting. Mean clinical follow-up was 13.4 months (range, 1-34 months). Of the 33 patients, two (6%) were cured of their hypertension, 20 (61%) were improved, and 11 (33%) did not respond to renal artery stenting. Of the 17 patients whose serum creatinine level was greater than 132 mumol/dl (1.5 mg/dl), seven (41%) were improved by renal artery stenting, six (35%) were stabilized, and renal function deteriorated in four (24%). Of the 33 patients, seven developed complications including one renal artery thrombosis, four renal artery emboli, one cholesterol embolization to the lower limbs, and one femoral hematoma that required surgery. Midterm results of renal artery stenting with the Palmaz stent to treat immediate or late angioplasty failures reveal improvements in blood pressure and renal function similar to those of successful primary balloon angioplasty.