Clinical Outcomes Of Stent Revascularization As Treatment For Atherosclerotic Renal Artery Stenosis

Objectives:To evaluate the safety and clinical efficacy of stent revascularization as treatment for atherosclerotic renal artery stenosis,and to analysed the predictors for clinical efficacy..Methods:In the prospective non-randomized cohort study in our hospital from January 2003 to October 2008,238 consecutive patients with severe atherosclerotic renal artery stenosis(ARAS)(diameter reduction≥60%) underwent percutaneous transluminal renal angioplasty and stenting(PTRAS) for severe hypertension and reserving renal function. They were followed up for 6-72 months and the effects of the procedure on renal function,blood pressure and cardiovascular events were observed.The predictors for improvement in blood pressure,renal function and cardiovascular events were analysed.Results:The success rate of stent revascularization was 99%.During 6～72 months of follow-up, both systolic and diastolic blood pressure significantly decreased(P＜0.05),and less antihypertensive medication was taken(P＜0.05).Serum creatinine was decreased significantly at 6～48 months(P＜0.05) and did not change significantly at 54～72 months (P＞0.05).Blood urea nitrogen was decreased significantly at 6～24 months(P＜0.05) and did not change significantly at 30～72 months(P＞0.05).Complications related with the procedure occurred in 13 cases(5.5%).23 patients failed to follow up(9.7%). Cardiovascular events occurred(10.1%) in 24 patients,including 5 cases of renal events (2.1%),4 cases of myocardial infarction(1.7%),4 cases of stroke(1.7%) and 11 cases of cardiovascular deaths(4.6%) during follow-up.The survival rates of free-of-events at year 1,2,3,4,5 and 6 were 92.7%(203/219),92.4%(146/158),82.9%(92/111),81.1% (60/74),66.7%(30/45) and 42.3%(11/26),respectively.The survival rates at year 1,2,3, 4,5 and 6 were 95.0%(208/219),92.4%(146/158),88.3%(98/111),81.1%(60/74),66.7% (30/45) and 42.3%(11/26),respectively.Higher baseline systolic blood pressure and more number of antihypertensive drugs taken before the procedure were independent predictors of improved blood pressure.Higher baseline serum creatinine was the independent predictor of improved renal function.Both improved blood pressure and improved renal function at 12 months were independent predictors of decreased mortality and decreased all cardiovascular events. Conclusions:Renal artery stenting as treatment for ARAS has a beneficial effect on blood pressure control and on renal function during mid-term and long-term follow-up.The treatment may be helpful in reduction of cardiovascular events and mortality,which should be investigated further.