P-533: Transluminal percutaneous renal angioplasty in the treatment of renovascular hypertension. Clinical results

Abstract

Purpose:

Renal percutaneous transluminal angioplasty (RPTA) in the treatment of artery stenosis involves conventional balloon angioplasty, with or without stenting. Conventional balloon angioplasty is considered the treatment of choice for patients (pts) with uncontrolled hypertension and fybromuscular dysplasia. In contrast, this proceeding is less effective for atherosclrerotic renal-artery stenosis. In the present study we analysed the clinical evolution of 79 consecutive pts submitted to unilateral conventional balloon angioplasty with or without stenting, during more than 12 months.

Patients and Methods:

The pts presents the following characteristics: Women: 46, Men: 33; Mean age of 56,2 +/− 10,1 years; SBP: 180 +/− 5.9 and DBP: 116.4 +/− 2.6 mm Hg; Fibromuscular dysplasia: 42; Atherosclerotic lesion: 37; 25 pts uncontrolled with two medications, 30 with three medications and 24 with four medications. Creatinine level > 1,5 mg/dl was present in 28 pts (37,3%). A stenosis was considered hemodinamically significant if there was greater than 50% luminal stenosis.After RPTA indications for stenting were a residual stenosis greater than 30% and ostial atherosclerotic renal artery stenosis.

Results:

Was achieved a primary technical success in 75 patients (94,9%). After balloon angioplasty 20 pts presented residual stenosis and implanted stents (2 of them implanted two stents and the remaining one stent). Primary stenting was performed in 4 pts with ostial stenosis. After 12 months a significant decrease in systolic and diastolic pressures were noted: 33 pts (44,0%) are cured and 36 ( 48,0%) improved ( 25 in monotherapy; 11 with two or more medication) by RPTA. The remaining 6 pts ( 8,0%) are uncontrolled. In the group with stenting 11 pts (45,8%) are cured against 22 pts (43,1%) without stenting. The endovascular stent improved 11 and uncontrolled 2 pts. After 12 months, 6 pts had significant restenosis (all pts included in the initial balloon angioplasty group without stenting). Complications occurred in 11 pts (15,9%): 7 hematoma, 2 renal artery thrombosis, 1 stent thrombosis and 1 fractured stent.

Conclusion:

We can conclude that RPTA with or without stenting is a safe and effective treatment of renal artery stenosis.

Renovascular Hypertension, Renal Angioplasty, Stenting

© American Journal of Hypertension, Ltd. 2002