RENAL-ARTERY STENT PLACEMENT - UTILITY IN LESIONS DIFFICULT TO TREAT WITH BALLOON ANGIOPLASTY

Objectives. We assessed the safety and efficacy of stent placement in patients with poorly controlled hypertension and renal artery stenoses , which are difficult to treat with balloon angioplasty alone. Backgro und. Preliminary experience with stent placement suggests improved res ults over balloon angioplasty alone in patients with atherosclerotic r enal artery stenosis. Methods. Balloon-expandable stents were placed i n 100 consecutive patients (133 renal arteries) with hypertension and renal artery stenosis. Sixty-seven of the patients had unilateral rena l artery stenosis treated and 33 had bilateral renal artery stenoses t reated with stents placed in both renal arteries. Results. Angiographi c success, as determined by quantitative angiography, was obtained in 132 (99%) of 133 lesions. Early clinical success was achieved in 76% o f the patients. Six months after stent placement, the systolic blood p ressure was reduced from 173 +/- 25 to 147 +/- 23 mm Hg (p < 0.001); t he diastolic pressure from 88 +/- 17 to 76 +/- 12 mm Hg (p < 0.001); a nd the mean number of antihypertensive medications per patient from 2. 6 +/- 1 to 2.0 +/- 0.9 (p < 0.001). Angiographic follow-np at a mean o f 8.7 +/- 5.0 months in 67 patients revealed restenosis (>50% diameter narrowing) in 15 (19%) of 80 stented vessels. Conclusions. Renal arte ry stenting is an effective treatment for renovascular hypertension, w ith a low angiographic restenosis rate. Stent placement appears to be a very attractive therapy in patients with lesions difficult to treat with balloon angioplasty such as renal aorto-ostial lesions and resten otic lesions, as well as after a suboptimal balloon angioplasty result . (C) 1997 by the American College of Cardiology.