Renal artery stenting for atherosclerotic renal artery stenosis identified in patients with coronary artery disease: Does captopril renal scintigraphy predict outcomes?

J Clin Hypertens (Greenwich). 2018 Feb;20(2):373-381. doi: 10.1111/jch.13160. Epub 2018 Jan 6.

Abstract

The authors evaluated the effectiveness of percutaneous renal revascularization (PRR) with stenting for the treatment of atherosclerotic renal artery stenosis (ARAS) in patients with coronary artery disease and the usefulness of captopril renal scintigraphy for predicting clinical outcomes after PRR. Sixty-four consecutive patients, referred for evaluation of suspected ARAS, after coronary angiography, underwent baseline captopril renal scintigraphy followed by renal angiography. Forty-four patients (68.7%) were diagnosed with a significant ARAS≥ 60% and were treated with PRR plus medical therapy. Twenty-four months after PRR, 86.4% and 73.3% of patients showed a hypertension and renal benefit, respectively. Captopril renal scintigraphy positivity had moderate sensitivity and high specificity in predicting a hypertension and renal benefit. In patients with ARAS≥ 70%, the sensitivity and specificity were 100% for both a hypertension and renal benefit.PRR for ARAS conferred a substantial benefit in patients with a high coronary artery disease burden. Captopril renal scintigraphy was highly accurate in predicting clinical outcomes.

Keywords: captopril renal scintigraphy; percutaneous renal revascularization; renal artery stenosis; renovascular hypertension.

MeSH terms

  • Aged
  • Angiography / methods
  • Angioplasty* / instrumentation
  • Angioplasty* / methods
  • Angiotensin-Converting Enzyme Inhibitors / pharmacology
  • Captopril / pharmacology*
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnosis
  • Female
  • Humans
  • Hypertension, Renovascular* / diagnosis
  • Hypertension, Renovascular* / etiology
  • Hypertension, Renovascular* / physiopathology
  • Kidney / blood supply*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Radionuclide Imaging / methods*
  • Renal Artery Obstruction* / diagnosis
  • Renal Artery Obstruction* / physiopathology
  • Renal Artery Obstruction* / surgery
  • Renal Artery* / diagnostic imaging
  • Renal Artery* / pathology
  • Stents*

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Captopril