The Clinical Comparison Of Interventional Therapy With Medicine Therapy For Atherosclerotic Renal Artery Stenosis (ARAS)

Objective:Atherosclerotic renal artery stenosis （ARAS） is closely related to cardiovasculardiseases such as refractory hypertension, recurrent flash pulmonary edema, recurrentheart failure, unstable angina. Interventional therapy can relieve artery stenosis, butclinical effects have been challenged. Through strict control indications forinterventional treatment, this research is to evaluate the clinical curative effects ofARAS patients who have been treated with drugs only and others treated withcombination therapy of drugs and intervention.Methods:Patients who were diagnosed as ARAS and renal artery stenosis area≥70%havebeen recruited during the period of January2010to January2011.Throughcomprehensive evaluations of kidney （renal size, renal artery stenosis degree, theipsilateral glomerular filtration rate, pressure gradients across renal artery stenosis）and clinical complications, patients have been divided into drug therapy group（patients refused interventional therapy） and drug therapy combined withinterventional therapy group. Recorded patients’ blood pressure, serum creatinine,cardiac function, cardiovascular events and readmission times before and aftertreatment. The patients were followed up for one year and then been evaluated for theclinical curative effect between drug therapy only and drug combined withintervertional therapy.Results:40patients were recruited,16cases in interventional group,24cases in druggroup, two groups had no significant differences in baseline data. In interventionalgroup, the blood pressure improved significantly[（175.0±16.6/92.4±4.4）mmHg/（140.0±12.8/79.4±9.3）mmHg,（1mmHg=0.133kPa）p＜0.01],1patient was cured,8patients blood pressure improved, seven cases were invalid, there were no signify-cant difference in the number of antihypertensive drug（1.56±0.96/1.96±0.97, p＞0.05）, average serum creatinine reduced mildly[（130.0±50.2）μmol·L^-1/（126.4± 42.3）μmol·L^-1，p＞0.05)]; Drug group needed to take more drugs to control bloodpressure （1.33±1.24/2.77±1.35, p＜0.01）, and average serum creatinine elevatedmildly（[110.4±31.7）μmol·L^-1（/114.9±30.8）μmol·L^-1，p＞0.05)]; While in the groupof ARAS patients combined with heart failure, interventional therapy can improveheart function of patients with heart failure, reduce the number of hospitalizations dueto heart failure, angina, pulmonary edema within1year.Conclusion:Intervention combined with drug therapy and drug therapy alone can botheffectively control blood pressure, however the patients in intervention combinedwith drug therapy team after treatment take fewer antihypertensive drugs, the curerate of hypertension was6%and50%of patients had improvement in blood pressure,44%of patients had no effect. Compared to drug therapy, intervention combined withdrug therapy can significantly improve patients’ cardiac function, reduce thereadmission caused by heart failure, angina and pulmonary edema of patients withARAS and heart failure. However, there was no significant effect on Serum creatininebetween the two groups.