Treatment Of Renal Artery Stenosis Research Articles

Interventions for renal artery stenosis: Appraisal of novel physiological insights and procedural techniques to improve clinical outcome.

Randomized clinical trials failed to show additional benefit of renal artery stenting on top of medical therapy. Instead of writing an obituary on renal artery stenting, we try to explain these disappointing results. A transstenotic pressure gradient is needed to reduce renal perfusion and to activate the renin-angiotensin-aldosterone system. In only a minority of patients included in trials, a transstenotic pressure gradient is measured and reported. Like the coronary circulation, integration of physiological lesion assessment will allow to avoid stenting of non-significant lesions and select those patients that are most likely to benefit from renal artery stenting. Renal artery interventions are associated with peri-procedural complications. Contemporary techniques, including radial artery access, no-touch technique to engage the renal ostium and the use of embolic protection devices, will minimize procedural risk. Combining optimal patient selection and meticulous technique might lead to a netto clinical benefit when renal artery stenting is added to optimal medical therapy.

Unrecognised autonomic dysreflexia in neurogenic lower urinary tract dysfunction with spinal cord injury as a reason for admission to a cardiac surgical unit

BACKGROUND: In Russia, spinal cord injury occurs in 0.7–6.8% of total injuries. Due to emergence of new rehabilitation protocols, it is extremely important to know the time of occurrence of consequences of spinal cord injury and adequate diagnosis of complications, which allows timely identification of life-threatening conditions of one of the body systems.
 Clinical case description. We present a clinical case of autonomic dysreflexia in neurogenic lower urinary tract dysfunction after traumatic cervical spinal cord injury in a 17-year-old girl. In traumatic spinal cord injury above the level of the sixth thoracic vertebra, autonomic dysreflexia as a variant of autonomic dysfunction is a common complication. This clinical case will be of interest to clinicians of all specialties who encounter patients with spinal cord injury. It is shown that misinterpreted symptoms of increased blood pressure during bladder filling were the cause of observation and treatment by a cardiologist for arterial hypertension, as well as hospitalization in the cardiac surgery department for planned surgical treatment of renal artery stenosis, which was thought to be the cause of the episodic increases in blood pressure. Lack of knowledge about the presence of autonomic dysfunction in spinal cord injury patients may have led to unnecessary surgical treatment. During the joint management of the patient with a pediatric cardiac surgeon, signs of autonomic dysreflexia were detected against the background of traumatic spinal cord disease at the level of the cervical spine, hypotensive treatment and planned surgical intervention were canceled.
 Conclusion. Subsequently, an adequate regimen of periodic bladder catheterization and antimuscarinic drug therapy was prescribed, which successfully reduced the dysreflexia.

Endovascular treatment of renal artery stenosis in Germany: aretrospective analysis of the DEGIR registry 2018-2021.

To provide an overview of endovascular treatment of renal artery stenosis (RAS) using the data of the Deutsche Gesellschaft für interventionelle Radiologie (DeGIR) quality management system. A retrospective analysis was performed. Pre-, peri- and postprocedural data, technical success rates, complication rates, and clinical success rates at dismissal were examined. Between 2018 and 2021, 2134 angiography examinations of the renal arteries were performed: diagnostic angiography in 70 patients (3 %), balloon angioplasty in 795 (37 %), stent implantation in 1166 (55 %) and miscellaneous procedures in 103 (5 %). The lesion length was less than or equal to 5 mm in 1837 patients (87 %), between 5 and 10 mm in 197 (9 %), and between 10 and 20 mm in 62 (3 %). The degree of stenosis was less than 50 % in 156 patients (7 %), greater than 50 % in 239 (11 %), and greater than 70 % in 1472 (70 %). Occlusion was treated in 235 patients (11 %). Symptoms at discharge resolved in 600 patients (29 %), improved in 1012 (49 %), were unchanged in 77 (4 %), and worsened in 5 (0.2 %). Complications were reported in 51 patients (2.5 %) and the mortality rate was 0.15 %. A substantial number of patients with RAS and occlusions were treated by radiologists in Germany, with high technical success rates and low complication rates. The indication should be determined carefully as the current European guidelines for the treatment of RAS suggest that only carefully selected groups of patients will benefit from recanalizing treatment. · Carefully selected patient groups may benefit from endovascular treatment of renal artery stenosis.. · Analysis of the DEGIR quality management database shows that treatment of renal artery stenosis was performed by radiologists in Germany with high technical success rates and low complication rates.. · Recanalization even led to symptom improvement in a large proportion of patients with occlusions..

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.

Five-Year Experience With the Zenith Fenestrated Endovascular Graft for Treatment of Juxtarenal Abdominal Aortic Aneurysms at a Medium Volume Center

The use of fenestrated endovascular aortic repair (FEVAR) to treat abdominal aortic aneurysms involving the visceral arteries has increased worldwide with excellent results. The aim of this study was to evaluate the safety and effectiveness of the Zenith fenestrated endovascular graft (Cook Medical, Bloomington, IN) for the treatment of juxtarenal abdominal aortic aneurysms (AAAs) at a medium volume center. We performed a 5-year (2015-2020) retrospective analysis of all patients who had presented to our institution with juxtarenal AAAs and undergone FEVAR. Custom-made fenestrated stent grafts were designed with one to three fenestrations after analysis of computed tomography data sets. Renal alignment was performed with balloon-expandable stents. Follow-up included clinical examination, laboratory studies, mesenteric-renal duplex ultrasound, abdominal radiography, and computed tomography at hospital discharge, at 1, 6, and 12 months, and annually thereafter for ≤5 years. A total of 25 patients with juxtarenal AAAs had undergone FEVAR during the study period and were included in our analysis. Of the 25 patients, 18 were men and 7 were women, with a mean age of 71 ± 10 years. The mean aneurysm diameter was 60 ± 5 mm. A total of 53 visceral arteries required incorporation with fenestrations. Of these, 51 (96%) fenestrations were aligned by stents. Technical success was 100%. One intraoperative complication occurred. The patient developed bilateral common femoral artery plaque dissection and required common femoral artery endarterectomy. The mean length of hospital stay was 2.8 ± 1.5 days. No aneurysm ruptures or conversions were noted during a mean follow-up of 41 ± 15 months (range, 6-67 months). Of a total of 50 renal arteries targeted by fenestration, one renal artery occlusion (2%) and five cases of stenosis (10%) developed. Five patients (20%) required secondary interventions for renal artery stenosis or occlusion. One type I endoleak developed in 2 patients and one type II endoleak developed in 11 patients. One patient with a type II endoleak had experienced an increase in sac size at 1 year and underwent inferior mesenteric artery ligation. None of the patients died during the follow-up period. Our study has demonstrated that endovascular repair of juxtarenal AAAs with the Zenith fenestrated AAA stent graft at a medium volume center is safe and effective. Mortality and morbidity are low for properly selected patients treated at centers with experience in these procedures.

MO400: Treatment of Renal Artery Stenosis: Nephrology, the Best Surgery

Abstract BACKGROUND AND AIMS Renal artery stenosis causes hypertension in 10–40% of severe cases or refractory to treatment. As a gold standard test for its diagnosis, we have arteriography, which allows the interventional therapeutic option, through angioplasty and/or stenting. There is no consensus on which patient profile would be the optimal candidate for each treatment. We tried to reach an answer by studying a cohort of 25 patients from our centre with a diagnosis of renal artery stenosis in the last 5 years. The objective was to assess the efficacy of isolated or interventional medical treatment with respect to renal function and the number of antihypertensive drugs. METHOD A retrospective observational cohort study was conducted. The study population was the patients who underwent renal arteriography in the last 5 years in our center (n = 25). We define significant stenosis as greater than 60%, bilateral involvement or of other main arteries. We compared the evolution of glomerular filtration in stages (KDIGO), proteinuria (albumin/creatinine ratio in urine) and number of antihypertensive drugs before and 6 months after the therapy used. RESULTS Renal arteriography was diagnostic in 18 patients: 13 of them presented significant stenosis, performing angioplasty in 4, stenting in 6 and angioplasty + stenting in 3. One antihypertensive drug was reduced in 17% of the patients, two in 22%, and one drug was increased in one of them. In 83% of the patients, the KDIGO stage of renal function did not change after treatment. An improvement was observed in three patients, who only received medical treatment. No differences were found in the evolution of proteinuria. CONCLUSION There were no statistically significant differences in renal function and the number of antihypertensive drugs between isolated medical versus medical and interventional treatment. It is necessary to expand the patient database, or start multicenter studies, to improve the significance.

Depression and anxiety in patients with suspected renal artery stenosis

Objective: To investigate the occurrence of depressive and anxiety disorders in patients remitted for endovascular treatment of renal artery stenosis (RAS), and whether symptoms of depression and anxiety can be reduced after the treatment of RAS with percutaneous transluminal renal angioplasty (PTRA). Methods Patients: Selected for renal angiography with pressure measurement in the renal arteries due to suspected RAS were invited to participate in the study. 37 patients agreed to answer a questionnaire. Eighteen patients also agreed to a clinical psychiatric examination including the International Neuropsychiatric Interview (M.I.N.I. 6.0) to be diagnosed according to the DSM-IV. Results: Twenty-one of the 37 patients completing the questionnaire were found to have a pressure gradient of ≥ 10 mmHg at angiography, indicating significant stenosis. Ten of the 18 examined patients met the criteria for current DSM-IV anxiety diagnosis and two patients had a current depression. Three of the 18 examined patients had previously made a suicide attempt. Conclusion: The results of this study suggest that patients with suspected RAS have a high psychiatric comorbidity, as 56% of the patients undergoing psychiatric examination met the DSM-IV criteria for a current anxiety disorder.

Abstract 15361: Comparison of Cardiovascular Outcomes of Supravalvar Aortic Stenosis Patients With Williams Syndrome and Non-williams Supravalvular Aortic Stenosis

Introduction: Cardiovascular outcomes in Williams syndrome (WS) with supravalvar aortic stenosis (SVAS) compared to those with non-Williams SVAS (NW-SVAS) have not been well-described in literature. Hypothesis: Cardiovascular outcomes are similar in SVAS patients in WS and those with NW-SVAS as both are typically mediated by elastin ( ELN ) deficiency. Methods: We included all patients (pts) at our institution with 1) WS and SVAS or 2) SVAS with negative testing for WS (2003-2020), excluding pts with Alagille or Turner syndrome, isolated bicuspid aortic valve, postoperative acquired SVAS, or insufficient records. We compared cardiovascular lesions and freedom from intervention using Kaplan-Meier analysis with comparison by log rank. Results: Of 163 included SVAS pts (67 WS, 96 NW-SVAS), 75 (46%) were females. Median age at last follow up was 11.9 years (IQR 5.7, 17). Of ELN testing performed in 13 NW-SVAS patients, 8 had pathogenic variants. The rest of the NW-SVAS cohort included 22 familial and 61 non-familial cases. Branch pulmonary artery stenosis (BPAS), renal artery stenosis (RAS), and hypertension were more prevalent in WS than in NW-SVAS (p=0.001, Table). There was no difference in freedom from BPAS intervention between the groups, but the WS group was significantly more likely to undergo intervention for RAS or be treated for hypertension (Figure). No difference was noted for SVAS, coarctation or coronary outcomes. Conclusion: For most cardiovascular lesions, there was no difference in interventions between WS and NW-SVAS. The increased intervention rate for RAS and hypertension in WS may reflect lower screening rates in NW-SVAS

Diagnosis and Treatment of Renal Artery Stenosis in China in the Era of Donation After Cardiac Death.

BackgroundThe aim of this study was to investigate the clinical features and treatment strategies of transplant renal artery stenosis (TRAS) with kidneys from donation after cardiac death (DCD).Material/MethodsWe collected the clinical data of donors and recipients of single-center DCD-induced TRAS from January 2015 to June 2017.ResultsAll the 8 cases of TRAS were from hypertensive cerebrovascular accident DCD-originated kidneys. The mean donor age was 53.5 (45~57) years, with mean BMI 27.8 (26.4~32.3) kg/m2, atherosclerosis index 5.8 (4.9~7.0), and renal atherosclerotic plaque. Clinical features of TRAS were: refractory hypertension with elevated serum creatinine >50%, and negative urine protein and occult blood. Ultrasound of transplanted kidneys showed renal blood flow index 0.49 (0.43~0.55). Angiography confirmed the diagnosis of renal artery trunk or secondary branch stenosis. There were 2 cases of moderate stenosis and 6 cases of severe stenosis. Six patients underwent stent implantation and 2 patients underwent balloon dilatation. Seven patients had serum creatinine recovery after interventional therapy during follow-up. The transplanted kidney of 1 patient ruptured 6 h after interventional therapy and was then resected.ConclusionsThe incidence of TRAS with hypertensive cerebrovascular accident DCD-originated kidneys is relatively high, which is a warning to kidney transplant physicians. Digital subtraction angiography (DSA) is the most reliable diagnostic means of TRAS and can be performed concurrently with intervention therapy. If the donor has severe atherosclerosis, plaques that are visible to the unaided eye in the renal artery trunk should be removed as completely as possible.

Percutaneous transluminal angioplasty with selective stenting for the treatment of renal artery stenosis caused by fibromuscular dysplasia: 18 years' experience from the China Center for Cardiovascular Disease.

This study aimed to evaluate the safety and efficiency of percutaneous transluminal angioplasty (PTA) with selective stenting treating Chinese patients with renal artery stenosis (RAS) due to fibromuscular dysplasia (FMD). Endovascular data of patients with RAS caused by FMD are scarce in China. Clinical data of 105 hypertensive patients with RAS caused by FMD underwent endovascular therapy at a single-site between June 2001 and October 2018 were analyzed retrospectively. Baseline blood pressure, use of antihypertensive medications, renal function, and adverse events at a 1-year follow-up were evaluated. The patients were aged between 10 and 64 years (mean age 26.7 ± 8.2 years) and 52 (49.5%) were female. In total, 105 patients undergoing endovascular therapy involving 124 RASs. Thirty (24.2%), sixty-four (51.6%), and thirty (24.2%) RASs were multifocal, unifocal, and tubular types, respectively. Ninety-four (89.5%) and eleven (10.5%) patients underwent PTA alone and PTA plus stenting, respectively. The technical success rate for endovascular therapy was 95.2% (100/105) without severe complications. During 1-year follow-up (n = 100), the mean systolic and diastolic blood pressure decreased from 157.6 ± 17.5 and 102.3 ± 14.2 to 129.6 ± 12.3 and 81.3 ± 11.1 mmHg, respectively, and the number of antihypertensive medications reduced from 2.2 ± 1.2 to 0.8 ± 1.0 (all p < .001). The cure rate and improved rate of blood pressure was 49.0 and 40.0%, respectively. The serum creatinine levels remained stable. The primary and secondary restenosis rate was 13.4 and 5.8%, respectively. Endovascular therapy for treating RAS caused by FMD was technically safe and effective for reducing blood pressure in Chinese patients.

In-hospital results of renal artery stenting in patients with multifocal atherosclerosis

A retrospective analysis of in-hospital results of renal artery stenting in patients with multifocal atherosclerosis. The study included 19 patients who underwent stenting for renal artery stenosis for the period 2011-2015 in the Kemerovo Cardiology Dispensary. Renal function was assessed considering glomerular filtration rate (GFR). Blood pressure and GFR were evaluated before the stenting procedure and at discharge. Stenting resulted optimal outcomes in all 19 patients. Severity of residual stenosis was 11±3%. In-hospital mortality was absent. Blood pressure in early postoperative period was similar to baseline values. One patient had a normalization of blood pressure up to 115-140/85-90 mm Hg without administration of antihypertensive drugs. Decrease of systolic blood pressure up to 155.3±32.6 mm Hg was noted in other patients at discharge. Blood creatinine levels decreased up to 0.167±0.56 mmol/L. In addition, mean GFR increased from 34.17 ml/min/1.69 m2 up to 37.16 ml/min/1.69 m2. Endovascular treatment of renal artery stenosis and secondary hypertension is effective and relatively safe approach.

Is stenting for atherosclerotic renal stenosis an effective technique?

IntroductionOne of the treatments for renal artery stenosis is endovascular intervention, but its effectiveness is controversial. The present study aims to analyze the experience of a working group in the endovascular treatment of selected patients with severe obstructive atherosclerotic lesions of the renal arteries, and to characterize early and late results. MethodsThis is a retrospective study of symptomatic patients with atherosclerotic renal artery stenosis who underwent endoluminal therapy between May 12, 1999 and March 12, 2015 at two institutions. Statistical analysis was performed using the PASW Statistics program. ResultsA total of 99 patients were treated, mean age 66 years and 76.8% male. The mean degree of stenosis measured by renal Doppler echocardiography was 83% and 64.6% were ostial lesions. Mean preoperative creatinine level was higher than the postoperative mean: 1.3 vs. 1.2 mg/dl (p=0.014). The number of antihypertensive drugs in the preoperative period was higher than in the postoperative period: 2.0 vs. 1.3 (p=0.001). The mean follow-up was 40 months (0-164). The mean peak systolic velocity over time in the postoperative period was 77 cm/s (40-250). The restenosis rate was 8%, and 30-day mortality was 0%. ConclusionsThe results demonstrated that the endovascular technique has a beneficial effect on blood pressure and renal function in selected patients, and is a safe technique associated with a high rate of technical success and few complications.

Endovascular Treatment of Renal Artery Stenosis Caused by Fibromuscular Dysplasia. A Clinical Case Report

Introduction. Fibromuscular dysplasia (FMD) is an idiopathic, non-atherosclerotic, non-inflammatory disease of arteries. Careful research into this disorder showed that FMD has been found in every arterial bed in the body; the most common arteries affected are renal arteries and extracranial sections of carotid and vertebral arteries. The clinical presentation is determined by the localization of the vasculature affected and the stenosis severity. Today FMD is a very rare disease with the incidence of 4 per 1000 people. The diagnosis today is difficult and may take a long time. According to the latest European Society of Cardiology guidelines renal artery balloon angioplasty is indicated for patients with FMD; if a good angiographic result is achieved (no dissection, TIMI 3 flow) no renal artery stenting required. The treatment success depends on the early diagnosis.Materials and Methods. This paper presents a clinical case of renal artery stenosis caused by fibromuscular dysplasia that was treated successfully with balloon angioplasty without stenting.Results and discussion. Protracted process of diagnosing this disease may result in deteriorating quality of life and poor outcomes such as difficult-to-control hypertension and its sequelae, TIA, stroke, aneurism dissection or rupture. It is worth pointing out that FMD diagnosis may be incidental when imaging is performed for other reasons, or when there is a systolic murmur at arteries in an asymptomatic patient who does not have classic atherosclerosis risk factors. According to the latest guidelines endovascular treatment is indicated for patients with FMD to manage the hypertension; this has proven very effective in improving quality of life.

Efficacy and indications of transradial and transfemoral approaches for peripheral artery stent implantation.

The transradial approach (TRA) has become an attractive alternative to the transfemoral approach (TFA) in percutaneous coronary intervention. To date, however, these two approaches have not been systematically compared in various percutaneous peripheral artery interventions (PPAIs). In the present study 258 patients with peripheral artery disease that underwent PPAI via the TRA (n=75) or the TFA (n=183) were analyzed. Clinical factors and outcomes in these two groups were compared. The puncture time was significantly longer (P<0.05) and the prevalence of artery vasospasm significantly higher (P<0.05) in patients who underwent PPAI via the TRA rather than via the TFA. However, the complication rate was significantly lower (P<0.05) and the artery compression time (P<0.05) and time bedridden (P<0.05) were significantly shorter via the TRA than via the TFA. These results suggest that PPAI via the TRA was associated with a lower complication rate, and shorter artery compression time and bedridden time than PPAI via the TFA. The TRA may be preferable for bilateral vertebral artery stenosis, whereas the TFA may be preferable for interventional treatment of carotid and subclavian artery stenosis. Therefore, the catheter length, artery support and push force should be comprehensively considered before choosing the TRA or TFA in the interventional treatment of renal artery stenosis.

The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization.

Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACCmax ≤ 1.3 m/s2) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.

Incidence and risk factors for restenosis, and its impact on blood pressure control after percutaneous transluminal renal angioplasty in hypertensive patients with renal artery stenosis.

Percutaneous transluminal renal angioplasty (PTA) is one of the standard treatments for renal artery stenosis (RAS). We investigated the frequency and risk factors for restenosis, and its impact on blood pressure (BP) control. A total of 175 hypertensive patients with RAS [mean age 60 years; 34% women; 30.3% fibromuscular dysplasia (FMD)] with 207 treated renal arteries were included and followed for more than 1 year without reangioplasty. Diagnosis of restenosis was based on duplex ultrasonographic findings, and data including BP and antihypertensive medication were collected consecutively. During follow-up (mean, 5.1 years), 56 patients (32.0%) developed restenosis. In multivariate Cox regression analysis, FMD was an independent predictor of restenosis (hazard ratio 2.65, P < 0.05). When divided into two groups based on FMD or atherosclerotic RAS (ARAS), the presence of previous cardiovascular disease (hazard ratio 2.84) as well as severe RAS (≥90%) (hazard ratio 3.95) in ARAS were independent predictors of restenosis (P < 0.05, respectively). At 1 year after PTA, 35 patients (20.0%) had developed restenosis. When divided into four groups on the basis of FMD or ARAS, and the absence/presence of restenosis at 1 year, the number of antihypertensive drugs was significantly lower in both FMD and ARAS patients without restenosis (P < 0.01, respectively); however, a significant difference in decrease in SBP (-31 ± 19 vs. -12 ± 25 mmHg, P < 0.05) as well as cure of hypertension (36.4 vs. 5.0%, P < 0.01) between the absence/presence of restenosis was found only in FMD patients. The frequency of restenosis after renal PTA is significant, and the presence of restenosis diminishes the benefit of its treatment, especially for FMD.

Endovascular Treatment of Renal Artery Stenosis in the Post CORAL Era.

Atherosclerotic renal artery stenosis (RAS) is highly associated with hypertension and renal insufficiency. Determining causation and who may benefit from RAS treatment remains difficult. The role of endovascular management of atherosclerotic RAS was challenged by several recent randomized controlled trials (RCT) which failed to demonstrate benefit of stenting. In the largest RCT to date, the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study did not find benefit of revascularization compared to medical therapy alone. While such RCTs represent the highest level of evidence to date, the conclusions drawn from them should be interpreted with caution due to substantial flaws in study design, inclusion, and exclusion criteria. The current AHA/ACC recommendations for RAS management are supported by many level-II evidence cohort studies which consistently found benefit of revascularization in groups with the highest likelihood of clinically significant RAS. Further study of these patient groups are needed to define a clear role for endovascular therapy of renal artery stenosis.

TCTAP A-114 Perioperative and Long Term Outcomes of Endovascular Treatment for Renal Artery Stenosis

TCTAP A-114 Perioperative and Long Term Outcomes of Endovascular Treatment for Renal Artery Stenosis

Renal Artery Stenting Associated With Improvement in Renal Function and Blood Pressure Control in Long-Term Follow-Up

Background/Aims: Clinical benefits of percutaneous treatment of renal artery stenosis (RAS) remain controversial. The aim of this study was to evaluate the effects of renal artery stenting on kidney function and blood pressure (BP) control in the log-term follow-up. Additionally angiographic follow up was performed in selected subgroup of patients. Methods: The study was designed as international registry of 265 consecutive patients with RAS treated with renal artery stenting. The primary end-point of the study was the change in renal function and blood pressure at long-term follow-up as compared with baseline values. Evaluation of the renal function was based on estimated glomerular filtration rate (eGFR) with the use of the modification of diet in renal disease (MDRD) formula. Results: All patients had clinical follow-up at the median time of 23.8 (interquartile range: 3-90) months during ambulatory visits. At follow-up eGFR improved in 53,9% of patients. These patients had lower pre-procedural systolic BP, more severe lesion type at baseline and lower diameter stenosis in control angiography. At follow up visits, SBP improvement was observed in 77,4% of patients. The average number of anti-hypertensive medications before the procedure and at follow up did not change significantly (2,70±1,0 vs 2,49±0,9, p=0,1). Restenosis rate based on control angiography performed at median time of 15 months was 12%. Conclusion: The results of the study suggest that interventional treatment of RAS may preserve renal function and improve blood pressure control at long-term follow-up.

Abstract 13892: Incidence and Risk Factors of Restenosis, and Its Impact on Blood Pressure Control After Percutaneous Transluminal Renal Angioplasty in Patients With Renovascular Hypertension

Background: Percutaneous transluminal renal angioplasty (PTRA) is one of the standard treatments for renal artery stenosis (RAS). Restenosis after PTRA may influence disease prognosis, but little is known about its frequency, risk factors, or impact on blood pressure control. Methods: This study included 175 renovascular hypertensive patients (mean age= 59.6 years; 33.7% women; 30.3% fibromuscular dysplasia [FMD]) with 207 treated renal arteries and were followed more than 12 months after PTRA. Data including blood pressure (BP), antihypertensive medication, and duplex ultrasonography (DUS) was collected before and 12 months, and then yearly after PTRA. Cure of hypertension was defines as a BP below 140/90mmHg without antihypertensive medication. Diagnosis of restenosis was based on DUS, by applying a renal aortic ratio &gt;3.5 in conjunction with a renal artery peak systolic velocity &gt; 250cm/s. Results: At 12 months after PTRA, the cumulative incidence of restenosis was 35 (20.0%). We divided the total patients into four groups on the basis of cause of RAS; FMD or atherosclerotic RAS (ARAS), and the absence/presence of restenosis, and found that the decrease in systolic BP (F=3.10, p&lt;0.05) as well as cure of hypertension (F=6.96, p&lt;0.01) were significantly different among the subgroups. Decrease in systolic BP (-31±19 vs -12±25mmHg, p&lt;0.05) as well as cure of hypertension (36.4 vs 5.0%, p&lt;0.01) were significantly greater in FMD patients without restenosis than those with restenosis; whereas no significant difference was found in patients with ARAS. During a median follow-up of 4.0 (IQR, 1.2-8.0) years, 56 patients (32.0%) developed restenosis. In multivariate Cox regression analysis, FMD was an independent predictor of restenosis (hazard ratio [HR] 2.65, p=0.02). We then divided total patients into two groups according to the cause of RAS, and found that statin use (HR 0.50) in FMD, and the presence of previous cardiovascular disease (HR 2.88) as well as severe RAS (≥90%) (HR 3.30) in ARAS were significant predictors of restenosis (p&lt;0.05, respectively). Conclusions: Incidence of restenosis after PTRA was higher in FMD than in ARAS among renovascular hypertensive patients. Assessment of restenosis is important for treatment success, especially for FMD.