RENAL-ARTERY STENOSIS MANAGED BY PALMAZ STENT INSERTION - TECHNICAL AND CLINICAL OUTCOME

Objective: To assess the technical and clinical outcome of Palmaz rena l artery stent insertion in patients with renal artery stenosis. Desig n: Twenty-nine patients with radiological evidence of renal artery ste nosis and hypertension (16 patients, mean+/-SD diastolic blood pressur e 100.5+/-8.16 mmHg) and/or renal impairment (17 patients, mean+/-SD s erum creatinine 376+/-169 mu mol/l) were referred for radiological int ervention. Of these, 22 had ostial atheromatous lesions, six had ather omatous non-ostial lesions and one patient had fibromuscular dysplasia . Palmaz stent insertion was performed where either previous or concom itant percutaneous transluminal renal angioplasty (PTRA) had been unsu ccessful. Technical success was defined primarily as <30% residual ste nosis. A prospective radiological and clinical follow-up was performed and the results compared with the outcome following PTRA alone in a s imilar group of patients from our centre. Results: Immediate technical success was achieved in all 29 patients. Follow-up angiography in 24 patients after a mean of 7 months showed restenosis in four patients. The hypertension was not 'cured' in any patient; a blood pressure fall was observed in seven patients (44%) and no change in the remaining n ine subjects (56%). Renal function improved in four patients (24%), tw o of whom had angiotensin converting enzyme inhibitor-exacerbated rena l impairment. This compares with an immediate technical success of 81% for PTRA alone, with cure in 50% and improvement in 32% of patients w ith hypertension and improvement in renal function in 64.7% of patient s with renal impairment. Conclusions: Palmaz renal artery stent insert ion has a higher technical success rate than PTRA, but the clinical im provement is disappointing in our patient population.