Renal Artery Stent Placement Research Articles

Type B Aortic Dissection Complicating Renal Artery Angioplasty and Stent Placement

Percutaneous renal artery stent placement has been demonstrated to improve blood pressure control and stabilize renal function in patients with atherosclerotic renal artery disease. However, this procedure is not without risk of significant morbidity, and its effectiveness, as compared to alternative treatments, has not been adequately established. The authors report a case of acute type B aortic dissection complicating renal artery stent placement. The authors postulate that an intimal disruption occurred during initial balloon angioplasty, and that repeated application of radial, shear, and torque forces during stent placement may have extended the injury. The diagnosis of acute aortic dissection should be considered in patients with suggestive symptoms immediately after stent placement.

Renal dysfunction and cardiac disease associated with high mortality in patients with renal artery stenosis and stent placement Mark W. Burket, David J. Kennedy, K C. Kurian, Sadik Khuder, William J. Thomas, Christopher J. Cooper, The Medical College of Ohio, Toledo, OH

Renal dysfunction and cardiac disease associated with high mortality in patients with renal artery stenosis and stent placement Mark W. Burket, David J. Kennedy, K C. Kurian, Sadik Khuder, William J. Thomas, Christopher J. Cooper, The Medical College of Ohio, Toledo, OH

Stent Placement for Renal Arterial Stenosis: Where Do We Stand? A Meta-analysis

To perform a meta-analysis of renal arterial stent placement in comparison with renal percutaneous transluminal angioplasty (PTA) in patients with renal arterial stenosis. Studies dealing with renal arterial stent placement (14 articles; 678 patients) and renal PTA (10 articles; 644 patients) published up to August 1998 were selected. A random-effects model was used to pool the data. Renal arterial stent placement proved highly successful, with an initial adequate performance in 98% and major complications in 11%. The overall cure rate for hypertension was 20%, whereas hypertension was improved in 49%. Renal function improved in 30% and stabilized in 38% of patients. The restenosis rate at follow-up of 6-29 months was 17%. Stent placement had a higher technical success rate and a lower restenosis rate than did renal PTA (98% vs 77% and 17% vs 26%, respectively; P <.001). The complication rate was not different between the two treatments. The cure rate for hypertension was higher and the improvement rate for renal function was lower after stent placement than after renal PTA (20% vs 10% and 30% vs 38%, respectively; P <.001). Renal arterial stent placement is technically superior and clinically comparable to renal PTA alone.

Renal artery angioplasty and stent placement: Predictors of a favorable outcome

Background Renal artery stenosis is a common disorder and is an established cause of hypertension and renal insufficiency. Although treatment with renal artery stents has been shown to improve blood pressure and renal function for some patients, the patient population most likely to benefit is unknown. The current study was designed to determine which factors are predictive of improved blood pressure and renal function when patients with renal artery stenosis are treated with renal artery angioplasty and stent placement. Methods In a prospective evaluation 127 consecutively enrolled patients with renal artery stenosis in 171 vessels were treated with angioplasty and intravascular stents. Blood pressure and serum creatinine concentration were measured before stent placement and during the follow-up period. Results The mean length of the follow-up period was 15 ± 14 months. Mean systolic blood pressure improved among patients with hypertension (from 177 ± 26 mm Hg before stent placement to 151 ± 24 mm Hg 6 months after stent placement ( P < .001). The greatest improvement occurred among those with the highest baseline systolic blood pressure. This beneficial effect on blood pressure was sustained for 3 years. Sex, age, diastolic blood pressure, number of vessels into which stents were placed, serum creatinine concentration, presence of bilateral disease, race, and severity of stenosis were not predictive of improved blood pressure. Mean creatinine concentration was not significantly changed for the group as a whole. A significant decrease in serum creatinine concentration occurred among 43% of patients with baseline renal insufficiency. None of the examined variables was predictive of improvement. Conclusions Renal artery angioplasty and stent placement produced a significantly greater reduction in systolic blood pressure among patients with the highest baseline systolic blood pressure. Other examined variables were not predictive of a significant improvement in blood pressure. No examined variable was predictive of improved renal function. We concluded that management of renal artery stenosis with renal artery angioplasty and stent placement is most likely to result in significant improvement in systolic blood pressure among patients with the highest baseline systolic blood pressure. (Am Heart J 2000;139:64-71.)

Renal artery angioplasty and stent placement: Predictors of a favorable outcome

Renal artery angioplasty and stent placement: Predictors of a favorable outcome

Renal Artery Stent Placement for the Management of Ischemic Nephropathy

Renal Artery Stent Placement for the Management of Ischemic Nephropathy

Renal Artery Stent Placement for the Management of Ischemic Nephropathy

Purpose To evaluate the angiographic and clinical results of percutaneously implanted renal artery endoprostheses (stents) for the treatment of patients with ischemic nephropathy. Materials and Methods During a 52-month period, 45 patients with azotemia (serum creatinine ≥ 1.5 mg/dL) and atheromatous renal artery stenosis untreatable by, or recurrent after, balloon angioplasty were treated by percutaneous placement of Palmaz stents. Stent implantation was unilateral in 32 cases and bilateral in 11 cases. Clinical results were determined by measurements of serum creatinine and follow-up angiography. Clinical benefit was defined as stabilization or improvement in serum creatinine level. Angiographic patency was defined as less than 50% diameter recurrent arterial stenosis. Results Stent placement was technically successful in 51 of 54 (94%) renal arteries. Technical failures were stent misdeployment requiring percutaneous stent retrieval ( n = 2) and inadvertent placement distal to the desired position ( n = 1). Complications included acute stent thrombosis ( n = 1) and early initiation of hemodialysis (within 30 days; n = 1). There were two periprocedural deaths. With use of life-table analysis, clinical benefit was seen in 78% of patients at 6 months ( n = 36), 72% at 1 year ( n = 24), 62% at 2 years ( n = 12), and 54% at 3 years ( n = 3). In patients with clinical benefit, average creatinine level was reduced from 2.21 mg/dL ± 0.91 before treatment to 2.05 mg/dL ± 1.05 after treatment ( P = .018). Lower initial serum creatinine level was associated with a better chance of clinical benefit ( P = .05). No other variables affected outcome, including patient age, sex, diabetes, implanted stent diameter, unilateral versus bilateral stent placement, or ostial versus nonostial stent positioning. Conventional catheter angiography or spiral computed tomographic (CT) angiography performed in 19 patients (28 stents) at a mean interval of 12.5 months demonstrated primary patency in 75%. Maintained stent patency appeared to correlate with renal functional benefit. Conclusions Percutaneous renal artery stent placement for angioplasty failures or restenoses provides clinical benefit in most patients with ischemic nephropathy.

Carbon Dioxide Digital Subtraction Angiography for Renal Artery Stent Placement

To determine the efficacy of renal artery stent placement with use of carbon dioxide as the primary contrast agent. Seventeen hypertensive patients with renal ostial stenosis were evaluated and underwent stent placement with use of CO2 digital subtraction angiography (DSA). Besides hypertension, 11 patients had decreased renal function, three had iodinated contrast material allergy, one patient had both, and two had neither. Supplemental iodinated contrast material (25 mL or less) was used in five patients. Preprocedure and postprocedure serum creatinine levels were obtained to evaluate the effect of CO2 on renal function. Arteriography was used to evaluate stent positioning. Twenty-three Palmaz stents were placed in 17 patients. Six placements were bilateral, with a total of nine right and 14 left. No additional stents were required to correct malposition. One patient had a mildly significant, yet transient, rise in the postprocedure creatinine level. This patient received 10 mL of iodinated contrast material in addition to CO2. There were no allergic reactions. The utilization of CO2 DSA facilitates the accurate placement of renal artery stents by eliminating the concern for contrast material-associated nephropathy and allergy. These attributes, coupled with the benefit of low viscosity, permit unrestricted imaging, guidance, and precise positioning not afforded by iodinated contrast material.

Impact of Screening MR Angiography on Referrals for Percutaneous Intervention in Renovascular Disease

Concern about contrast- and catheter-induced complications inhibits liberal use of catheter angiography to screen for renal artery stenosis. The authors evaluated the impact on interventional practice growth of offering magnetic resonance angiography (MRA) as an alternative screening test for renovascular disease. A retrospective analysis of 339 patients with renovascular disease identified with MRA from January 1, 1993 through December 31, 1997, and the subsequent utilization of follow-up catheter angiography and/or intervention was performed. The number of patients treated per year with percutaneous techniques for renovascular disease was recorded, and was correlated with screening MRA. The impact of screening MRA on percutaneous management of renovascular disease was evaluated through comparisons of the number of percutaneous procedures performed among the individual years during the 5-year period, and with the number of procedures performed during the 5-year period (1988-1992) immediately preceding 1993, prior to the use of screening MRA. The number of annual screening MRA examinations increased six-fold during the 5-year period, from 17 per year initially to approximately 100 per year for each of the last 3 years. One hundred thirty-five (40%) of screening MRA examinations were positive for renal artery stenosis or occlusion, and 111 (33%) patients had anatomy potentially suitable for percutaneous intervention. Fifty-two patients with positive screening MR angiograms underwent arteriography: 34 underwent renal angioplasty or stent placement, seven had surgery, seven with stenosis determined with MRA had occlusion on catheter angiography, and four had false-positive results of MRA (<50% stenosis). Three additional patients with negative screening MR angiograms were also referred for arteriography, which confirmed the MRA findings. The percentage of positive catheter angiograms was 50% greater among patients with a screening MRA, and the number of renal artery angioplasties performed annually doubled. Moreover, comparison with the 5-year period from 1988 to 1992 (immediately prior to the use of MRA as a screening tool), demonstrates that the average number of renal artery percutaneous procedures performed per year increased nearly 350% from an average of three per year to 15 per year. These findings are entirely attributable to referrals from screening MRA. Marketing of renal artery MRA as a safe, noninvasive outpatient screening technique can lead to improved utilization of catheter angiography in evaluation of renovascular disease, and can secondarily increase the volume of renal artery angioplasty and stent placement procedures for treatment of renovascular disease.

Recurrent Hypertension After Migration of a Renal Artery Stent

The use of angioplasty and intravascular stenting has been applied to a variety of arterial lesions including atherosclerotic renal artery stenosis (RAS). The authors describe a patient with renovascular hypertension who underwent angioplasty and subsequent right renal artery stent placement for proximal RAS. Recurrent hypertension 4 months after the procedure led to arteriography that documented distal migration of the stent into the renal hilum and restenosis of the proximal vessel. Operative stent removal and revascularization was required to correct the problem.

Renal artery stent placement in patients seventy-five years of age or older

Renal artery stent placement in patients seventy-five years of age or older

Infected Renal Artery Pseudoaneurysm and Mycotic Aortic Aneurysm After Percutaneous Transluminal Renal Artery Angioplasty and Stent Placement in a Patient With a Solitary Kidney

Endovascular infections after percutaneous transluminal renal angioplasty with stenting (PTRAS) are rarely reported. Because strict longitudinal follow-up of patients undergoing PTRAS is lacking, the true incidence of such complications remains obscure. We report the first case of a patient with an infected renal artery pseudoaneurysm and de novo mycotic aortic aneurysm after PTRAS. This case serves to illustrate several important points, including (1) the retrieval of renal function in patients with renal artery occlusion, (2) the pathogenesis of infection after PTRAS, (3) the diagnosis and management of endovascular infection after percutaneous vascular intervention, and (4) recommendations for periprocedural antibiotic prophylaxis during PTRAS.

Infected Renal Artery Pseudoaneurysm and Mycotic Aortic Aneurysm After Percutaneous Transluminal Renal Artery Angioplasty and Stent Placement in a Patient With a Solitary Kidney

Infected Renal Artery Pseudoaneurysm and Mycotic Aortic Aneurysm After Percutaneous Transluminal Renal Artery Angioplasty and Stent Placement in a Patient With a Solitary Kidney

Prevention of recurrent pulmonary edema in patients with bilateral renovascular disease through renal artery stent placement

Pulmonary edema and congestive heart failure (both referred to here as PE) have been reported to be complications of bilateral renal artery stenosis or unilateral stenosis in a solitary functioning kidney (both referred to as BRAS). The goals of this study were to determine whether a history of PE was more common in patients with BRAS than in those with unilateral stenosis and a normal contralateral kidney (URAS), and whether recurrent PE could be prevented by renal artery stent placement. We evaluated 90 consecutive patients with renovascular disease who were treated with percutaneous renal artery stent placement. History and clinical follow-up were obtained through chart review and phone contact with referring physicians. Mean follow-up was 18.4 months after stent placement. Twenty-three of 56 (41%) subjects with BRAS had a history of PE before revascularization, compared with four of 34 (12%) subjects with URAS ( P = .05). Twenty-five of the 27 patients with history of PE had adequate clinical follow-up. Seventeen of the 22 (77%) subjects with BRAS and history of PE had no further PE after stent placement in one or both renal arteries. The five BRAS subjects with recurrent PE after stent placement had evidence of stent thrombosis or restenosis. In contrast, only one of three (33%) URAS subjects with a history of PE remained free of PE after stent placement. We conclude that PE is a common complication of BRAS, but not of URAS. In patients with BRAS, recurrent PE can be prevented by successful stent placement in one or both renal arteries.

Fluoroscopic Landmarks for Optimal Visualization of the Proximal Renal Arteries

To accurately determine the in vivo orientation of the origin of the renal arteries from the aorta relative to a fluoroscopic bony landmark for optimal diagnostic arteriography and renal artery stent placement. One hundred sixty abdominal computed tomography (CT) scans of patients in eight age groups (20-90 years) were reviewed to determine the angle of the origins of the renal arteries from the aorta relative to the long axis of the L-1 spinous process (L1SP). The right renal artery arises ventrally at an angle of 30 degrees (standard deviation [SD] = 15 degrees) from a plane orthogonal to the long axis of the L1SP. The left renal artery arises dorsally at an angle of 7 degrees (SD = 13 degrees) relative to the same plane. The optimal initial angle for angiographic evaluation of the origin of the renal artery and for renal artery stent placement is 30 degrees left anterior oblique (LAO) relative to the L1SP for the right renal artery and 7 degrees LAO for the left renal artery. Unfortunately, there is variability in the angle of the renal artery origins from the aorta which cannot be controlled for using this technique. In some patients, additional views will be necessary to optimally depict the origins of the renal arteries.

Stent Placement for Treatment of Renal Artery Stenosis Guided by Intravascular Ultrasound

To study the impact of intravascular ultrasound (IVUS) during renal artery stent placement. Patients (n = 22) with atherosclerotic renal artery stenosis were studied with IVUS after predilation and after angiographically successful stent deployment (diameter stenosis < 10%). After predilation, IVUS was used to assess whether the balloon size selected angiographically was correct (discrepancy balloon-reference lumen diameter < 20%). After stent placement, IVUS images were assessed for (i) complete stent-vessel wall apposition; (ii) complete stent expansion (discrepancy stent-reference lumen diameter < 20%), and (iii) complete lesion covering by the stent. Modification based on IVUS included selection of a larger balloon, additional dilation, and placement of a second stent. Clinical outcome was based on blood pressure, amount of antihypertensive drugs, and glomerular filtration rate during follow-up of 3 months. Stent placement and ultrasound imaging were completed successfully in 18 patients. After predilation, IVUS warranted the use of a larger balloon in five patients. After stent placement, incomplete stent apposition (n = 1), discrepancy between stent and reference lumen diameter (n = 3), and lesion distal to the stent (n = 2) seen on IVUS were treated with additional dilation in five patients and with a second stent in one patient. A larger balloon was used in three patients. Mean blood pressure and amount of antihypertensive drugs decreased (P < .05). In a number of patients, IVUS monitoring during renal artery stent placement resulted in additional lumen enlargement not considered necessary at angiography.

Ostial renal artery stent placement for atherosclerotic renal artery stenosis in patients with coronary artery disease.

To test the utility of endoprosthetic treatment for ostial renal artery stenosis, and to examine blood pressure and its treatment, serum creatinine, and restenosis rate, 44 ostial renal stent placements were performed in 30 patients with concomitant coronary artery disease, arterial hypertension, and the indication for angiotensin converting enzyme (ACE) therapy. There was a marked decrease in systolic and diastolic blood pressure (163+/-30 to 145+/-17 and 93+/-18 to 83+/-10 mm Hg; P < 0.008) with a decrease in number of medication (3.2+/-0.9 to 2.8+/-1.0; P = 0.005). In 5 out of 8 patients not receiving an ACE inhibitor, this drug could be added. Serum creatinine changed from 1.46+/-0.7 mg/dl to 1.39+/-0.58 mg/dl (P = ns). Three patients showed restenosis (12.5%). Ostial stenting lowers blood pressure, decreases antihypertensive drugs and increases medication flexibility.

Infected renal artery pseudoaneurysm and mycotic aortic aneurysm after percutaneous transluminal renal artery angioplasty and stent placement in a patient with a solitary kidney

Endovascular infections after percutaneous transluminal renal angioplasty with stenting (PTRAS) are rarely reported. Because strict longitudinal follow-up of patients undergoing PTRAS is lacking, the true incidence of such complications remains obscure. We report the first case of a patient with an infected renal artery pseudoaneurysm and de novo mycotic aortic aneurysm after PTRAS. This case serves to illustrate several important points, including (1) the retrieval of renal function in patients with renal artery occlusion, (2) the pathogenesis of infection after PTRAS, (3) the diagnosis and management of endovascular infection after percutaneous vascular intervention, and (4) recommendations for periprocedural antibiotic prophylaxis during PTRAS. (J Vasc Surg 1998;28:340-4.)

Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis

No AccessJournal of UrologyUrological Survey: Abstracts: Kidney Transplantation and Renovascular Hypertension1 Jun 1998Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis F.J.A. Beek, R. Kaatee, J.J. Beutler, P.J. van der Ven, and W.P.T.M. Mali F.J.A. BeekF.J.A. Beek More articles by this author , R. KaateeR. Kaatee More articles by this author , J.J. BeutlerJ.J. Beutler More articles by this author , P.J. van der VenP.J. van der Ven More articles by this author , and W.P.T.M. MaliW.P.T.M. Mali More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63327-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis." The Journal of Urology, 159(6), pp. 2245–2246 References 1 : Atheroembolic renal disease: association with renal artery stenosis. Cleveland Clin. J. Med.1988; 56: 407. Google Scholar Departments of Radiology and Nephrology, University Hospital Utrecht, Utrecht, The Netherlands© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 159Issue 6June 1998Page: 2245-2246 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information F.J.A. Beek More articles by this author R. Kaatee More articles by this author J.J. Beutler More articles by this author P.J. van der Ven More articles by this author W.P.T.M. Mali More articles by this author Expand All Advertisement PDF DownloadLoading ...

Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis

Complications During Renal Artery Stent Placement for Atherosclerotic Ostial Stenosis