Primary renal artery stenting: Characteristics and outcomes after 363 procedures

R. J. Lederman, F. O. Mendelsohn, R. Santos, H. R. Phillips, R. S. Stack, J. J. Crowley

Research output: Contribution to journalArticle

227 Citations (Scopus)

Abstract

Background: Stenting improves the acute results of percutaneous balloon angioplasty for atherosclerotic renal artery stenosis. Predictors of benefit and angiographic restenosis are not well understood. We describe the technical and clinical success of renal artery stenting in a large consecutive series of patients with hypertension or renal insufficiency. We identify clinical, procedural, and anatomic factors that might influence outcome, restenosis, and survival. Methods: Primary renal artery stenting was performed in 300 consecutive patients who underwent 363 stent procedures in 358 arteries. Angiograms were analyzed quantitatively. Clinical and angiographic follow-up data are available after a median of 16.0 months. Results: At baseline, 87% of patients had hypertension, and 37% had chronic renal insufficiency. The mean age was 70 years (interquartile range 63.1-74.6) years. The stenosis was unilateral in 49% and bilateral in 48% and involved a solitary functioning kidney in 3.6%. The stenting procedure was successful in all attempts. There were no procedural deaths or emergency renal surgical procedures. Postprocedure azotemia was seen in 45 of 363 (12%) procedures but persisted in only 6 patients (2%), all of whom had baseline renal insufficiency. Systolic and diastolic blood pressures were significantly reduced (systolic blood pressure from 164.0 ± 28.7 to 142.4 ± 19.1 mm Hg, P < .001). At follow-up, 70% of patients had improved blood pressure control regardless of renal function. In patients with baseline renal insufficiency, 19% had improvement in serum creatinine levels at follow-up, 54% had stabilization, and 27% had deterioration. Follow-up mortality was 10% and was predicted by baseline creatinine levels (odds ratio 1.72 for each 1 mg/dL creatinine increment, 95% confidence interval 1.13-2.49) and extent of coronary artery disease (odds ratio 1.66 for each diseased coronary artery, 95% confidence interval 1.03-2.67). Angiographic restenosis was found in 21% of 102 patients overall and was less common (12%) in arteries with a reference caliber >4.5 mm (P <.01 vs caliber <4.5 mm). Neither poststenotic dilation nor severity of angiographic stenosis predicted clinical outcome. Conclusions: Primary renal artery, stenting can be performed safely with nearly uniform technical success. The majority of patients with hypertension or renal insufficiency derive benefit. Follow-up mortality is 5-fold higher in patients with baseline renal insufficiency. Clinical and angiographic features did not predict blood pressure or renal functional outcome. Restenosis is more common in renal arteries with a reference caliber less than 4.5 mm.

Original languageEnglish
Pages (from-to)314-323
Number of pages10
JournalAmerican Heart Journal
Volume142
Issue number2
DOIs
StatePublished - Aug 14 2001
Externally publishedYes

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Renal Artery
Renal Insufficiency
Blood Pressure
Hypertension
Kidney
Pathologic Constriction
Azotemia
Renal Artery Obstruction
Balloon Angioplasty
Chronic Renal Insufficiency
Stents
Dilatation
Angiography
Emergencies
Arteries
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lederman, R. J., Mendelsohn, F. O., Santos, R., Phillips, H. R., Stack, R. S., & Crowley, J. J. (2001). Primary renal artery stenting: Characteristics and outcomes after 363 procedures. American Heart Journal, 142(2), 314-323. https://doi.org/10.1067/mhj.2001.116958

Primary renal artery stenting : Characteristics and outcomes after 363 procedures. / Lederman, R. J.; Mendelsohn, F. O.; Santos, R.; Phillips, H. R.; Stack, R. S.; Crowley, J. J.

In: American Heart Journal, Vol. 142, No. 2, 14.08.2001, p. 314-323.

Research output: Contribution to journalArticle

Lederman, RJ, Mendelsohn, FO, Santos, R, Phillips, HR, Stack, RS & Crowley, JJ 2001, 'Primary renal artery stenting: Characteristics and outcomes after 363 procedures', American Heart Journal, vol. 142, no. 2, pp. 314-323. https://doi.org/10.1067/mhj.2001.116958
Lederman RJ, Mendelsohn FO, Santos R, Phillips HR, Stack RS, Crowley JJ. Primary renal artery stenting: Characteristics and outcomes after 363 procedures. American Heart Journal. 2001 Aug 14;142(2):314-323. https://doi.org/10.1067/mhj.2001.116958
Lederman, R. J. ; Mendelsohn, F. O. ; Santos, R. ; Phillips, H. R. ; Stack, R. S. ; Crowley, J. J. / Primary renal artery stenting : Characteristics and outcomes after 363 procedures. In: American Heart Journal. 2001 ; Vol. 142, No. 2. pp. 314-323.
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abstract = "Background: Stenting improves the acute results of percutaneous balloon angioplasty for atherosclerotic renal artery stenosis. Predictors of benefit and angiographic restenosis are not well understood. We describe the technical and clinical success of renal artery stenting in a large consecutive series of patients with hypertension or renal insufficiency. We identify clinical, procedural, and anatomic factors that might influence outcome, restenosis, and survival. Methods: Primary renal artery stenting was performed in 300 consecutive patients who underwent 363 stent procedures in 358 arteries. Angiograms were analyzed quantitatively. Clinical and angiographic follow-up data are available after a median of 16.0 months. Results: At baseline, 87{\%} of patients had hypertension, and 37{\%} had chronic renal insufficiency. The mean age was 70 years (interquartile range 63.1-74.6) years. The stenosis was unilateral in 49{\%} and bilateral in 48{\%} and involved a solitary functioning kidney in 3.6{\%}. The stenting procedure was successful in all attempts. There were no procedural deaths or emergency renal surgical procedures. Postprocedure azotemia was seen in 45 of 363 (12{\%}) procedures but persisted in only 6 patients (2{\%}), all of whom had baseline renal insufficiency. Systolic and diastolic blood pressures were significantly reduced (systolic blood pressure from 164.0 ± 28.7 to 142.4 ± 19.1 mm Hg, P < .001). At follow-up, 70{\%} of patients had improved blood pressure control regardless of renal function. In patients with baseline renal insufficiency, 19{\%} had improvement in serum creatinine levels at follow-up, 54{\%} had stabilization, and 27{\%} had deterioration. Follow-up mortality was 10{\%} and was predicted by baseline creatinine levels (odds ratio 1.72 for each 1 mg/dL creatinine increment, 95{\%} confidence interval 1.13-2.49) and extent of coronary artery disease (odds ratio 1.66 for each diseased coronary artery, 95{\%} confidence interval 1.03-2.67). Angiographic restenosis was found in 21{\%} of 102 patients overall and was less common (12{\%}) in arteries with a reference caliber >4.5 mm (P <.01 vs caliber <4.5 mm). Neither poststenotic dilation nor severity of angiographic stenosis predicted clinical outcome. Conclusions: Primary renal artery, stenting can be performed safely with nearly uniform technical success. The majority of patients with hypertension or renal insufficiency derive benefit. Follow-up mortality is 5-fold higher in patients with baseline renal insufficiency. Clinical and angiographic features did not predict blood pressure or renal functional outcome. Restenosis is more common in renal arteries with a reference caliber less than 4.5 mm.",
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N2 - Background: Stenting improves the acute results of percutaneous balloon angioplasty for atherosclerotic renal artery stenosis. Predictors of benefit and angiographic restenosis are not well understood. We describe the technical and clinical success of renal artery stenting in a large consecutive series of patients with hypertension or renal insufficiency. We identify clinical, procedural, and anatomic factors that might influence outcome, restenosis, and survival. Methods: Primary renal artery stenting was performed in 300 consecutive patients who underwent 363 stent procedures in 358 arteries. Angiograms were analyzed quantitatively. Clinical and angiographic follow-up data are available after a median of 16.0 months. Results: At baseline, 87% of patients had hypertension, and 37% had chronic renal insufficiency. The mean age was 70 years (interquartile range 63.1-74.6) years. The stenosis was unilateral in 49% and bilateral in 48% and involved a solitary functioning kidney in 3.6%. The stenting procedure was successful in all attempts. There were no procedural deaths or emergency renal surgical procedures. Postprocedure azotemia was seen in 45 of 363 (12%) procedures but persisted in only 6 patients (2%), all of whom had baseline renal insufficiency. Systolic and diastolic blood pressures were significantly reduced (systolic blood pressure from 164.0 ± 28.7 to 142.4 ± 19.1 mm Hg, P < .001). At follow-up, 70% of patients had improved blood pressure control regardless of renal function. In patients with baseline renal insufficiency, 19% had improvement in serum creatinine levels at follow-up, 54% had stabilization, and 27% had deterioration. Follow-up mortality was 10% and was predicted by baseline creatinine levels (odds ratio 1.72 for each 1 mg/dL creatinine increment, 95% confidence interval 1.13-2.49) and extent of coronary artery disease (odds ratio 1.66 for each diseased coronary artery, 95% confidence interval 1.03-2.67). Angiographic restenosis was found in 21% of 102 patients overall and was less common (12%) in arteries with a reference caliber >4.5 mm (P <.01 vs caliber <4.5 mm). Neither poststenotic dilation nor severity of angiographic stenosis predicted clinical outcome. Conclusions: Primary renal artery, stenting can be performed safely with nearly uniform technical success. The majority of patients with hypertension or renal insufficiency derive benefit. Follow-up mortality is 5-fold higher in patients with baseline renal insufficiency. Clinical and angiographic features did not predict blood pressure or renal functional outcome. Restenosis is more common in renal arteries with a reference caliber less than 4.5 mm.

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