| PART Ⅰ ANALYSIS OF THE OUTCOME OF THE TREATMENT OF RENAL ARTERY STENTING FOR PATIENTS WITH RENAL ARTERY STENOSIS IN THE WESTERN CHINAObjective: To compare the change of blood pressure, renal function, and adverse cardiovascular events in the process of follow-up between the group of revascularization and the medical therapy. To find out the specific characteristics of the patients who will likely benefit from renal revascularization. To provide suggestion of the therapy for patients with renal artery stenosis.Methods: Between 2010-1-1 and 2015-4-30 205 cases of atherosclerotic renal artery stenosis(ARAS) in the Western China diagnosed by renal artery angiography were included in the study, including 167 cases of revascularization and 38 cases of medical therapy. All the patients’ change of blood pressure, renal function, and incidence of adverse cardiovascular events were followed. Endpoints for evaluation of the outcome included: change of blood pressure and renal function, and incidence of adverse cardiovascular events. Researchers identified the patients who were beneficial from renal revascularization in blood pressure and adverse cardiovascular events. The results were analyzed in correlation with the baseline characteristics of the patients.Results: The systolic pressure of the patients of revascularization was decreased by 21.19±22.50 mm Hg(P﹤0.001), and the diastolic pressure was decreased by 9.68±14.93 mm Hg(P﹤0.05), before and after follow-up. The systolic pressure of the control was decreased by 8.80±16.04 mm Hg(P﹤0.02), before and after follow-up. The drop of pressure of the revascularization before and after follow-up was higher than that of the control. Change of renal function of the two groups’ before and after follow-up was not obvious. Serum creatinine of the patients with chronic kidney disease in the group of revascularization at the end of follow-up was increased by 72.20±114.37mmol/L(P ﹤ 0.01). The revascularization of cardiovascular events of the patients whose heart function between Ⅲ to Ⅳ of revascularization was more than those of the patients whose heart functionⅠ ~ ﹤ Ⅲ. Blood pressure of 58.1 percent of the patients of revascularization was decreased. The decreasing of blood pressure was in correlation with the patients’ age, bilateral renal artery stenosis, systolic blood pressure, peripheral artery stenosis and hyperlipidemia at baseline.The incidence of cardiovascular events of 89.6 percent of the patients of revascularization was improved. The incidence of adverse cardiovascular events was in correlation with the patients’ bilateral renal artery stenosis, heart function and diabetes at baseline.Conclusion: At the experienced center, the patients whose degree of renal artery stenosis was more than 60% and whose heart function was Ⅰ~﹤Ⅲ were chosen for revascularization as early as possible, they will more likely benefit from operation in terms of blood pressure, renal function and the incidence of adverse cardiovascular events.PARTⅡ CLINICAL TRIAL ON THE RENAL ARTERY STENTING AND MEDICAL THERAPY FOR PATIENTS WITH ATHEROSCLEROTIC RENAL ARTERY STENOSISObjective: To accomplish the clinical trial design for renal artery stenting and single medical therapy for patients with atherosclerotic renal artery stenosis. Clinical trial was implemented at Second Affiliated Hospital of Chongqing Medical University, comparing the outcome of renal artery stenting and medical therapy on RAS, so as to provide suggestion to the treatment for RAS clinically.Methods: The clinical trials and the implementation plan were designed according to the results of the first section, suggestions from European Society of Cardiology(ESC) for diagnosis and treatment for peripheral vascular diseases, in consideration of medical care, patients, and technical conditions of the center. 9 cases of RAS at Second Affiliated Hospital of Chongqing Medical University were included in the trial by renal artery angiography. 6 cases who were implanted renal artery stenting were grouped in the revascularization group, while 3 cases who weren’t implanted renal artery stenting were grouped in the control group. Researchers collected the baseline data of the patients in two groups before operation, results of renal artery angiography and angioplasty, renin system before and after operation, results of renal ultrasound before and after operation, blood pressure, antihypertensive drugs and renal function after 6 months of follow-up, evaluated the curative effects of hypertension by renal artery stenting, and analyzed the diagnosis value of renin system and renal artery ultrasound before operation.Results: In the section, the inclusion and exclusion of patients with renal artery stenosis(RAS) and grouping methods have been clearly defined, the patients’ operation scheme, medical therapy and time and content of regular follow-up were demonstrated clearly, and the endpoints needed to be observed and its statistical methods were also described in detail. The systolic and diastolic pressure of the 6 patients of the experimental group were decreased by 40.33±30.43 mm Hg and 17.17±19.53 mm Hg, respectively. The systolic and diastolic pressure of the 3 patients of the control group were decreased by 22.67±16.26 mm Hg and 4±6mm Hg, respectively. There are 4 patients with resistant blood pressure in the revascularization group, and their blood pressure controlled better after operation. The patients of the experimental groups took 3±0.63 and 2.67±0.82 antihypertensive drugs before and in the sixth month after operation. 9 patients’ renal function were not abnormal before and in the sixth month after follow-up, their serum creatinine was 90.01±24.70mmol/L and 92.27±23.14mmol/L, respectively. Renin system of only 2 patients of the 9 patients was higher than normal, the others were not found abnormal. 4 patients of 9 patients were examined by renal artery ultrasound demonstrating increased renal artery resistance or increased renal artery velocity showing renal artery stenosis.Conclusions: The design is of great value for the guidance of the implementation the clinical trial. Renal artery stenting may achieve better effects of decreasing blood pressure than simple medical therapy. Special meaning of examination of renin system were not found. Renal artery ultrasound before operation to obtain the distal and proximal pressure instead of renal angiography was not fulfilled. The clinical trial was limited to time scope and a few patients included. We are failed to get more practical data about the choice of patients and methods for diagnosis of operation. But the direction is right and desirable, more cases are needed to be collected for analysis and evaluation, in order to achieve the purpose of the trial. |
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