Atherosclerotic Ostial Renal Artery Stenosis Research Articles

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

Cardiovascular Disease Prevention in Patients With Atherosclerotic Renovascular Disease-Induced Resistant Hypertension: Further Considerations for 24-Hour BloodPressure Profiles.

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

Renal artery stenosis: Up-date on diagnosis and treatment

Significant renal artery stenosis (RAS) can cause or result in deterioration of arterial hypertension and may promote the development of renal insufficiency. The activation of the renin-angiotensin-aldosterone system results in structural heart disease and may impact patient survival. Technical improvements of diagnostic and interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy during the past two decades. Whereas balloon angioplasty is still the method of choice for the treatment of fibromuscular dysplasia, stent implantation is indicated in ostial atherosclerotic RAS. However, none of the so far published or presented randomized controlled trials could prove a beneficial outcome of RAS revascularization compared to medical management. As a result of these negative trials including the largest published trial to date, the ASTRAL trial, referrals to endovascular renal artery revascularization have declined and, moreover, reimbursement of these procedures has become a matter of debate. Crucial for a clinical benefit following revascularization of RAS is proper patient selection, revascularization being only indicated after proof of hemodynamic relevance of RAS. This article summarizes the appropriate diagnostic work-up of patients with suspected RAS, discusses the limitations of the results published so far and their impact on the indication for RAS revascularization.

Use of Registries to Complement Clinical Trials in Renal Artery Stenting

The role of renal artery stenting in the treatment of atherosclerotic lesions of renal artery remains intensely debated. There were similar debates several times in interventional cardiology arena, and interestingly the data in renal artery stenting have followed the same footsteps. Use of registry data helped in the debate on many issues in cardiology, and we make a case for use of registries to complement clinical trials in renal artery stenting. Rapid developments followed after Dr Gruntzig pioneered treatment of atherosclerotic blockages in coronary and renal arteries with angioplasty. Results in the first 50 patients who underwent percutaneous transluminal coronary angioplasty (PTCA), the primary success rate was only 64%, and emergency coronary bypass surgery (CABG) was required in 14%, with a periprocedural myocardial infarction (MI) rate of 6%. Subsequently, as a result of greater operator experience and refinements in catheter and imaging technology, acute complication rates of balloon angioplasty steadily decreased. However, restenosis and the need for repeat intervention remained a severe limitation, occurring in up to 40% of cases. An alternative strategy evolved and in 1986, Sigwart performed first stent implantation in a human coronary artery. Restenosis was soon recognized to be a major problem that found viable solution in the form of drug-eluting stents, first of which was approved by the Food and Drug Administration (FDA) in 2003. Initial treatment of ostial renal atherosclerotic lesions was limited by a low acute technical success rate of 50% to 62% and a high restenosis rate of up to 47% in the long term due to dissections, elastic recoil, and rigidity of the lesion in calcified stenoses. Single-center reports of stenting started trickling in 1990s. Two randomized studies proved the superiority of stenting over conventional balloon angioplasty in terms of acute treatment success and technical durability of the endovascular treatment of atherosclerotic ostial renal artery stenosis (RAS). Larger clinical trials were required to define the indications for interventional treatment of RAS. Unfortunately, 3 prospective randomized controlled clinical trials (RCTs) that have been published on the subject thus far have failed to provide clear answers. With the exception of Stenting for Renal Artery Lesions (ASTRAL) trial, the studies were underpowered to provide meaningful answers. All the trials enrolled patients with limited disease burden (stenosis <70%) and who had little plausible survival benefit from intervention versus medical therapy. Large number of patients did not receive the intended treatment and the statistical analysis was performed on intention-to-treat basis that could never account for high crossover rates. A large national institute of health funded Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial that will randomize over 900 participants with greater than 60% stenosis to stenting and optimal medical therapy or medical therapy alone is underway. Recruitment for this trial has also been slow and research protocol has undergone multiple revisions to ease the recruitment process. The primary end point is survival free of cardiovascular and renal adverse events. The results of this trial are awaited. Sketching parallels, Taggart elaborated that trials evaluating the use of drug-eluting stents in multivessel coronary disease faced similar problems. The trials systematically enrolled patients with limited disease burden and who had little plausible survival benefit from surgery versus medical therapy. In the mentioned trials, more than 90% of screened patients were excluded from randomization as they did not meet the inclusion criteria. The investigations only represented a small portion of the spectrum of multivessel disease, but their results were used to justify percutaneous coronary intervention (PCI) in much more anatomically complex patients without corroborating evidence. Evidence from total population-based studies such as the New York State registry indicates that when all patients are considered, CABG provides superior survival in the setting of all patients with left anterior descending coronary artery disease and at least 1 other diseased vessel.

Renal artery intervention

Renal artery stenosis may cause or deteriorate arterial hypertension and/or renal insufficiency. Technical improvements of diagnostic and interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularisation and extension of the indications for this type of therapy. The first renal artery balloon angioplasties were performed by Felix Mahler in Berne and Andreas Gruentzig in Zurich in 19771,2. Until the beginning of the 1990’s balloon angioplasty was the only method of percutaneous treatment of renal artery stenosis (RAS). Results were satisfying for stenoses caused by fibro-muscular dysplasia and atherosclerotic stenosis of the renal artery trunk, but limited for ostial atherosclerotic lesions, the most common manifestation of renal artery stenosis3,4. The introduction of stenting has revolutionised percutaneous renal revascularisation. Following promising single centre reports, two randomised studies proved the superiority of stenting over conventional balloon angioplasty3,5 in the treatment of atherosclerotic ostial renal artery stenosis. Nowadays using pre-mounted low profile stent devices atherosclerotic RAS can be treated successfully in almost all cases with restenosis rates ranging from 0 to 23% depending on the diameter of the renal artery5-9. Even if the recent randomised STAR and ASTRAL trials10,11 did not show any benefit of renal artery stenosis revascularisation over medical therapy there is nonetheless evidence that stenting of haemodynamically relevant atherosclerotic renal artery stenosis has an impact on blood pressure control, renal function, and left ventricular hypertrophy. A proper patient selection and a safe interventional technique are the key elements of a clinically successful outcome of the patient following the procedure. In particular, patients with a short history of deterioration of renal function might have the largest benefit from intervention. In patients with an advanced stage of renal failure the indication for stenting of atherosclerotic renal artery stenosis must be determined individually for each patient considering the overall prognosis. The online version of this manuscript introduces step-bystep into interventional treatment techniques for renal artery stenoses, from the simple guiding catheter technique to the modified “no-touch” technique (Figure 1a-e) or the telescope technique to access renal arteries with steep angulations from the femoral artery.

Sirolimus-eluting stent placement for refractory renal artery in-stent restenosis: sustained patency and clinical benefit at 24 months

Renal artery stenosis may cause or exacerbate hypertension and renal failure. Percutaneous transluminal renal artery stent placement, increasingly the first-line therapy for ostial atherosclerotic renal artery stenosis, can be complicated by in-stent restenosis weeks to months after the procedure. There is currently no consensus for the treatment of in-stent restenosis. Sirolimus-eluting stents have been shown to be effective to treat in-stent restenosis in the coronary circulation. We report a case of sustained 24-month patency after repair of recurrent renal artery in-stent restenosis with use of a sirolimus-eluting stent.

MDCT Angiography of the Renal Arteries in Patients with Atherosclerotic Renal Artery Stenosis: Implications for Renal Artery Stenting with Distal Protection

Use of distal protection in renal artery stenting entails overcoming challenges unique to renal artery anatomy. We used 3D image reconstruction to review high-spatial-resolution MDCT angiographic data to better characterize the anatomy of stenotic renal arteries. A total of 218 abdominal MDCT angiograms from a single tertiary care referral center were reviewed. The subjects were 108 patients who had 127 arteries with more than 50% ostial atherosclerotic renal artery stenosis. Vessel analysis software was used to measure renal artery length, cross-sectional area, and maximum diameter. Differences between mean values for women and men and for left and right renal arteries were measured with a two-tailed Student's t test. Significant differences for men and women were found in average maximum cross-sectional area distal to the point of stenosis (0.3 +/- 0.19 vs 0.23 +/- 0.09 cm2, p = 0.006) and the corresponding maximum diameter (6.9 +/- 1.7 vs 6.1 +/- 1.1 cm2, p = 0.003). Average lengths of the main renal artery did not differ significantly for men and women. Differences for the left and right main renal arteries were found in minimum area (i.e., area of maximum stenosis, 0.08 +/- 0.04 vs 0.06 +/- 0.03 cm2, p = 0.03), area proximal to the bifurcation (0.26 +/- 0.11 cm2 vs 0.23 +/- 0.07 cm2, p = 0.02), and length (38.5 +/- 12.6 vs 48.7 +/- 16.2 mm, p = 0.0002). Significant anatomic differences exist between the left and right renal arteries, between the renal arteries in men and those in women, and from one person to the next. Many of these differences are relevant to the design and use of distal protection devices in stenting of the renal arteries.

Virtual endoscopy in renal artery stenosis: an innovative approach for diagnosis and follow-up.

We investigated the utility of virtual endoscopy (VE) as a diagnostic and follow-up tool in patients with renal artery stenosis, especially as a means of defining vascular patency. We performed VE in 24 patients with ostial atherosclerotic renal artery stenosis and correlated the results with those of conventional angiography. The patients were treated successfully by placement of metal stents and conventional catheter angiography and VE for patency assessment 6 and 12 months after stent insertion. In all patients, the stenotic segment was identified, and VE findings were concordant with those of angiography. The average degree of stenosis was estimated to be 70% +/- 20% when angiography was used and 62% +/- 15% when VE was used. After metal stent insertion, the 12-month patency rate was 83.3% (20 patients). Angiography and VE findings remained concordant during the follow-up period, but VE provided more information beyond the stenotic segment, allowing examination of the arterial lumen both cephalad and caudal to the point of obstruction. Virtual endoscopy provided a more dynamic, direct, minimally invasive approach that was equal to or better than angiography for both the verification of the vascular stenosis and the evaluation of the arterial lumen.

Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis

BACKGROUND CONTEXT: After cervical corpectomy, the use of tricortical autologous bone to fill the large defect is biomechanically and structurally inadequate and may lead to excessive donor site pain and morbidity. The major alternative, fibular strut allograft, has inherent problems that lead to lower rates of solid arthrodesis and graft migration. Majd et al. reported on 34 cases with a 97% solid fusion rate using titanium mesh cages and local bone graft to fill the cervical corpectomy defect.PURPOSE: With long-term results, to confirm the results previously reported by Majd et al.STUDY DESIGN/SETTING: Retrospective chart and radiological review.PATIENT SAMPLE: The first 26 patients in the senior author's practice eligible for a minimum 2-year follow-up, having had cervical corpectomy reconstructed with titanium mesh cages, local bone graft and anterior plating.OUTCOME MEASURES: Odom's criteria were used to assess clinical outcome. Anteroposterior, lateral and lateral flexion and extension radiographs were used to assess fusion.METHODS: Twenty-six patients with multilevel cervical pathology underwent successful corpectomy, decompression and fusion with titanium mesh cages filled with local bone graft. Rigid anterior plating was applied across the corpectomy defect. Preoperative, operative and postoperative chart data were collected retrospectively. Radiographic assessment included a minimum 2-year follow-up.RESULTS: Follow-up ranged from 24 to 64 months. Clinically, 21 of 26 (80.7%) had an excellent or good clinical outcome. No radiolucencies or motion were detected on radiographic analysis, yielding a fusion rate of 100% (26 of 26). Broken or pulled out screws were identified in two patients, one of whom had plate revision. All cages remained intact with no evidence of cage settling or collapse.CONCLUSIONS: The use of titanium mesh cages in conjunction with local bone graft, and rigid anterior plating is effective for cervical reconstruction after corpectomy and a viable alternative to the use of fibular strut allograft. These results confirm those previously reported by Majd et al.

Repeated Intervention for In-Stent Restenosis of the Renal Arteries

To assess the long-term technical success of repeated endovascular intervention in stenosed renal artery stents. Fifteen patients with stenoses >or=50% in a renal stent placed because of an ostial atherosclerotic renal artery stenosis were included in this study. In the presence of increased blood pressure or decreased renal function, the in-stent restenosis was treated with percutaneous transluminal angioplasty (PTA) in the stent or placement of a second stent if the stenosis was located too distally in the stent. The results of these repeat interventions were evaluated by angiography. The 15 patients had a total of 20 stenosed stents. Eighteen of these in-stent stenoses were treated with PTA and two were treated with placement of a second stent. Angiographic follow-up was available in 16 arteries, showing in-stent restenosis in four (25%; mean follow-up, 11 mo). The cumulative patency rates after repeat endoluminal intervention were 93% (95% CI: 80%-106%) and 76% (95% CI: 52%-101%) after 6 and 12 months, respectively. Renal function remained stable or improved in most patients (80%) after repeated intervention in the stent, and hypertension was classified as improved or cured in 47% of patients after 1 year. Patients with stenosed renal artery stents can be treated successfully with PTA in a majority of cases, with a long-term success rate of 75% and stable renal function 1 year after repeated intervention.

Metal stents for the management of atherosclerotic renovascular disease.

We report on our experience with the use of metal stents for the treatment of atherosclerotic renovascular disease. Since 1996, 62 patients (mean age 67 years) with ostial atherosclerotic renal artery stenosis were treated successfully by placement of metal stents. All patients presented with renovascular hypertension, and eight had additionally impaired renal function. In 12 patients, stents were placed bilaterally. In 54 patients, the introduction of stents was performed as the primary mode of treatment, and in the remaining 8 patients, the positioning of the endoprosthesis was deemed necessary because of recurrence of stenosis previously treated by renal percutaneous transluminal angioplasty (PTA). The patients were followed for a mean period of 18 months (range 9-48 months). Positioning of the endoprosthesis was successful in all patients. No major complications were reported. The 18-month patency rate was 77.4% (48 patients). Hypertension resolved in 39 patients and showed a trend to improvement in 15 patients. We observed no improvement of renal function in the eight patients who had impaired function prior to the procedure. Implantation of metal stents is a safe and effective method for the treatment of atherosclerotic renal artery stenosis and certainly presents an important alternative to renal PTA.

Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal insufficiency.

It is uncertain whether renal artery stent placement in patients with atherosclerotic renovascular renal failure can prevent further deterioration of renal function. Therefore, the effects of renal artery stent placement, followed by patency surveillance, were prospectively studied in 63 patients with ostial atherosclerotic renal artery stenosis and renal dysfunction (i.e., serum creatinine concentrations of >120 micromol/L (median serum creatinine concentration, 171 micromol/L; serum creatinine concentration range, 121 to 650 micromol/L). Pre-stent renal (dys) function was stable for 28 patients and declining for 35 patients (defined as a serum creatinine concentration increase of > or =20% in 12 mo). The median follow-up period was 23 mo (interquartile range, 13 to 29 mo). Angioplasty to treat restenosis was performed in 12 cases. Five patients reached end-stage renal failure within 6 mo, and this was related to stent placement in two cases. Two other patients died or were lost to follow-up monitoring within 6 mo, with stable renal function. For the remaining 56 patients, the treatment had no effect on serum creatinine levels if function had previously been stable; if function had been declining, median serum creatinine concentrations improved in the first 1 yr [from 182 micromol/L (135 to 270 micromol/L ) to 154 micromol/L (127 to 225 micromol/L ); P < 0.05] and remained stable during further follow-up monitoring. In conclusion, stent placement, followed by patency surveillance, to treat ostial atherosclerotic renal artery stenosis can stabilize declining renal function. For patients with stable renal dysfunction, the usefulness is less clear. The possible advantages must be weighed against the risk of renal failure advancement with stent placement.

Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial

Percutaneous transluminal angioplasty (PTA) for ostial atherosclerotic renal-artery stenosis has poor results. Angioplasty with stent placement (PTAS) may be more effective. We undertook a randomised prospective study to compare PTA with PTAS in patients with ostial atherosclerotic renal-artery stenosis. Patients with ostial atherosclerotic renal-artery stenosis were assigned to receive PTA or PTAS. Secondary PTAS was allowed if PTA failed immediately or during 6 months' follow-up. Analysis was by intention to treat. 42 patients were assigned PTA and 43 were assigned PTAS, but one patient in the PTAS group was excluded from the study. Primary success rate (<50% residual stenosis) of PTA was 57% (24 patients) compared with 88% (37 patients) for PTAS (difference between groups 31% [95% CI 12-50]). Complications were similar. At 6 months, the primary patency rate was 29% (12 patients) for PTA, and 75% (30 patients) for PTAS (46% [24-68]). Restenosis after a successful primary procedure occurred in 48% of patients for PTA and 14% for PTAS (34% [11-58]). 12 patients underwent secondary stenting for primary or late failure of PTA within the follow-up period: success was similar to that of primary PTAS. Evaluation based on intention to treat showed no difference in clinical results at six months for PTA or PTAS. PTAS is a better technique than PTA to achieve vessel patency in ostial atherosclerotic renal-artery stenosis. Primary PTAS and primary PTA plus PTAS as rescue therapy have similar outcomes. However, the burden of reintervention after PTA outweighs the potential saving in stents, so primary PTAS is a better approach to use.

Renal angioplasty and stenting

Renal vascular hypertension is underdiagnosed in the symptomatic atherosclerotic patient population, especially those with unstable angina, congestive heart failure, cerebrovascular disease, peripheral vascular disease, and/or poorly controlled hypertension. Revascularisation and stenting for atherosclerotic ostial renal artery stenosis can dramatically alter patients' clinical course. Patients with significant and disabling angina or recurrent pulmonary oedema often improve after renal stenting, without undergoing any coronary revascularisation procedure. The acute and long-term results of renal artery stenting are equal to or superior to the results of coronary stenting. The rationale for treating RAS includes preventing disease progression, preserving renal function, managing recurrent congestive heart failure, managing recurrent angina and treating hypertension. 24–31

Treatment of atherosclerotic ostial renal artery stenosis with the intravascular stent.

Traditional approaches to revascularization for atherosclerotic ostial renal artery stenosis (RAS) have been suboptimal because of the invasiveness and relatively high perioperative morbidity and mortality of surgery and the low rates of success and long-term patency with percutaneous renal angioplasty (PTRA). We report our 5-year (1991 to 1996) experience with the intravascular stent (Palmaz stent; Johnson & Johnson, Miami Lakes, FL) for the treatment of ostial RAS in 129 patients (63 men, 66 women) and 148 arteries. The mean age of the patients was 71+/-10 years; 98% were hypertensive and 57% had renal dysfunction. Angiographic characteristics of RAS were unilateral in 78%, bilateral in 15%, and single kidney in 7%. The technical success rates were 98% for stent versus 11% for PTRA in the ostial location. The stent restenosis rate (angiographic) was 14% at 8+/-5 months. Systolic and diastolic blood pressures were as follows: baseline, 158+/-3 and 84+/-2 mm Hg; 6 months, 149+/-3 and 81+/-2 mm Hg; 12 months, 149+/-3 and 79+/-2 mm Hg; and 24 months, 135+/-3 and 79+/-2 mm Hg. Follow-up values were significantly lower than baseline (P < 0.05). The number of medications for hypertension initially decreased from 2.2+/-0.1 at baseline to 1.6+/-0.1 and 1.8+/-0.1 at 1 and 3 months, respectively (P < 0.05). By 6 months, however, the number of medications had increased and was not significantly different from before stent placement. Renal function was stable in the group as a whole: Cockroft-Gault creatinine clearance (C-G CrCl) at baseline was 40+/-2 mL/min; at 6 months, 36+/-3 mL/min; at 12 months, 39+/-3 mL/min; and at 24 months, 39+/-4 mL/min. When stratified by degree of renal function, values were similarly stable. Patients with a baseline serum creatinine level of 2 mg/dL or less had C-G CrCl values as follows: baseline, 53+/-3 mg/dL; 6 months, 43+/-4 mg/dL; 12 months, 46+/-4 mg/dL; and 24 months, 52+/-5 mg/dL. Those with a baseline serum creatinine level greater than 2 mg/dL had C-G CrCl values as follows: baseline, 26+/-2 mg/dL; 6 months, 31+/-4 mg/dL; 12 months, 32+/-6 mg/dL; and 24 months, 23+/-3 mg/dL. Of eight patients who were dialysis dependent, four (50%) recovered renal function with a mean serum creatinine level of 2.3+/-0.5 mg/dL at 15+/-6 months (range, 9 to 24 months). Stent placement for the treatment of atherosclerotic ostial RAS has a high success rate and a low rate of restenosis. Control of hypertension improves in most patients. Renal function stabilizes or improves in the majority of patients, even those with severe renal failure. These favorable outcomes are maintained long term.

Ostial Renal Artery Stenosis Angioplasty: Immediate and Mid-term Angiographic and Clinical Results

To report the immediate results and the clinical and angiographic outcome of percutaneous angioplasty in patients with ostial renal artery stenosis. Retrospective review of 52 percutaneous transluminal renal angioplasty (PTRA) procedures for strictly defined ostial atherosclerotic renal artery stenosis in 50 consecutive patients, selected among 670 PTRAs performed between 1983 and 1993. Immediate angiographic success was achieved in 30 arteries (58%) and improvement was achieved in 15 arteries (29%). The procedure was a failure in seven lesions (13%). PTRA was followed by a stent implantation in three lesions (6%). Two patients (4%) died within the first month after PTRA and a major complication occurred in seven other patients (13%). At a mean follow-up of 20.6 months, both systolic and diastolic blood pressure decreased significantly (P = .0006 and P = .0057 respectively). Renal function did not change significantly (P = .73). One patient was lost during follow-up. At angiographic control (mean, 11 months), restenosis occurred in 27% of the cases. There was no recurrence of pulmonary edema at a mean follow-up of 32 months in 50% of the 12 patients who experienced one episode or more before PTRA. True ostial renal artery stenosis is rare and often reflects severe and multifocal atheromatous disease. In these patients, PTRA might be considered an acceptable and relatively safe treatment that improves blood pressure and stabilizes renal function.

Progressive renal dysfunction despite successful renal artery angioplasty in a single kidney

Atherosclerotic renovascular disease is an important cause of renal impairment. 1 Scoble JE The epidemiology and clinical manifestations of atherosclerotic renal disease. in: Novick A Scoble J Hamilton G Renal vascular disease. WB Saunders, London1995: 303-314 Google Scholar Angioplasty with or without stenting has been used successfully to improve renal function in these patients. However, the changes in plasma creatinine are difficult to interpret because the functional status of the contralateral kidney is often unclear. 2 Van de Ven PJG Beitler JJ Kaatee R et al. Transluminal vascular stents for ostial atherosclerotic renal artery stenosis. Lancet. 1995; 346: 672-674 Summary PubMed Google Scholar We describe four patients investigated for renal dysfunction in whom stenosis was shown in one renal artery and occlusion in the other. In each case, the stenosis caused a greater than 50% reduction in diameter. Divided renal function was determined by a 99mTechnetium dimercaptosuccinic acid (99mTc-DMSA) scan. Patients did not have renal biopsy or an angiotensin-converting-enzyme inhibitor after angioplasty. There was no reduction in antihypertensive medication after angioplasty.

Transluminal vascular stent for ostial atherosclerotic renal artery stenosis

We implanted transluminal stents in 24 hypertensive patients with a critical atherosclerotic ostial renal artery stenosis (28 arteries). Immediate revascularisation was successful in all. Follow-up angiography at 6 months, available in 18 patients, revealed restenosis twice. In another patient restenosis was suspected and confirmed by angiography at 2 months. Hence, the total restenosis rate was 3 of 19 patients (16%) and 3 of 23 arteries (13%). Two patients developed renal insufficiency due to cholesterol embolism. In the remaining 22 patients renal function improved (n=8) or stabilised (n=14). Although all had to resume antihypertensive treatment, blood pressure normalised in 15 patients, improved in one, remained unchanged in five and worsened in one.

Original Papers: A NOTE ON SUGGESTION.

<i>Abstract</i>. It is uncertain whether renal artery stent placement in patients with atherosclerotic renovascular renal failure can prevent further deterioration of renal function. Therefore, the effects of renal artery stent placement, followed by patency surveillance, were prospectively studied in 63 patients with ostial atherosclerotic renal artery stenosis and renal dysfunction (<i>i.e.</i>, serum creatinine concentrations of &gt;120 μmol/L (median serum creatinine concentration, 171 μmol/L; serum creatinine concentration range, 121 to 650 μmol/L). Pre-stent renal (dys) function was stable for 28 patients and declining for 35 patients (defined as a serum creatinine concentration increase of ≥20% in 12 mo). The median follow-up period was 23 mo (interquartile range, 13 to 29 mo). Angioplasty to treat restenosis was performed in 12 cases. Five patients reached end-stage renal failure within 6 mo, and this was related to stent placement in two cases. Two other patients died or were lost to follow-up monitoring within 6 mo, with stable renal function. For the remaining 56 patients, the treatment had no effect on serum creatinine levels if function had previously been stable; if function had been declining, median serum creatinine concentrations improved in the first 1 yr [from 182 μmol/L (135 to 270 μmol/L) to 154 μmol/L (127 to 225 μmol/L); <i>P</i> &lt; 0.05] and remained stable during further follow-up monitoring. In conclusion, stent placement, followed by patency surveillance, to treat ostial atherosclerotic renal artery stenosis can stabilize declining renal function. For patients with stable renal dysfunction, the usefulness is less clear. The possible advantages must be weighed against the risk of renal failure advancement with stent placement.