Long-Term Follow-up of Renal Artery Stenting in an Australian Population

Background

Renal artery stenosis comprises both atherosclerotic renovascular disease and fibromuscular dysplasia, and may be associated with refractory hypertension, acute ‘flash’ pulmonary oedema and renal failure. The long-term clinical effects of renal artery stenting remain unclear.

Aim

To assess the procedural and long-term safety and efficacy of renal artery stenting and its effect on blood pressure, antihypertensive medication usage and serum creatinine.

Methods

All patients referred for renal artery stenting at our institution between September 1997 and December 2003 were entered into a prospectively collected database. Systolic and diastolic blood pressure, number of antihypertensive medications, serum creatinine and estimated glomerular filtration rate (eGFR) were recorded. Patients were followed-up at least six months post-procedure.

Results

Eighty-nine patients underwent renal arteriography, with 110 stents deployed in 102 lesions. The procedural success rate was 99% with no procedural mortality. There were two cases of peri-procedural haemorrhage and one of sepsis. One patient developed renal and peripheral atheroemboli.

Follow-up

Mean follow-up was 28 months (range 6 months–7 years). Eight patients were lost to follow-up. There were nine deaths with a mean time to death of 20.7 months (range 12 months–3 years). There was a highly statistically significant fall in systolic blood pressure (BP) from 161.7±29.5mmHg pre-procedure to 138.7±17.9mmHg at long-term follow-up post-procedure (p<0.0001). The clinical restenosis rate was 6.2%. Renal function and eGFR remained stable and there was a borderline significant decrease in the number of antihypertensive medications used (p=0.05).

Conclusion

Renal artery stenting is safe and appears effective for the treatment of clinically significant renal artery stenosis.

Keywords: Renal artery stenosis (RAS), Atherosclerotic renovascular disease (ARVD), Fibromuscular dysplasia, Percutaneous transluminal renal angioplasty (PTRA)