Objective: To evaluate the safety, as well as short term and long term effect of percutaneous angioplasty and stenting in atherosclerotic renal artery stenosis.
Methods: A total of 150 consecutive patients with atherosclerotic renal artery stenosis (ARAS) undergoing percutaneous transluminal renal angioplasty (PTRA) and stenting in a period of 6 years were followed up. Blood pressure, renal function before and after the procedure were monitored through-out the follow up years. Renal artery restenosis was tested with ultrasound and Doppler 6-9 months after the procedure. Clinically drive repeat angiogram was done in some patients.
Results: 96% of the patients had coronary artery disease and 54% triple vessel disease. A total of 174 renal arteries were found to have severe ARAS in these 150 patients. Procedure success rate was 99.3% with only 1 failure. 3 total occluded renal artery were not attempted, with a total of 170 renal arteries receiving PTRA and stenting. There was no immediate complication such as death, renal artery rupture or acute closure. 145 patients were clinically followed up, with a follow-up rate of 98.6%, and a follow up time between 7 months and 5 years. During follow-up, another 2 patients died in addition to the 3 died in the hospital. All of them died of cardiovascular disease. As to blood pressure, 66 patients among 101 with refractory hypertension and 20 among 42 with well controlled hypertension got improved in 6-9 months of follow up, with an improvement rate of 60.1%. These effects were kept throughout the follow up years. Most of the patient's renal function kept stable and a small number of patient's serum creatine level ameliorating. Renal artery restenosis was found in 10 among the 166 renal vessels undergoing ultrasound examination, with a restenosis rate of 6.0%.
Conclusion: PTRA and stenting in ARAS patients with coronary artery disease are safe and effective, most of the patient's blood pressure can be controlled and renal function can be kept stable. Restenosis rate is quite low and acceptable.