TREATMENT OF OSTIAL RENAL-ARTERY STENOSES WITH VASCULAR ENDOPROSTHESES AFTER UNSUCCESSFUL BALLOON ANGIOPLASTY

Background Percutaneous transluminal renal angioplasty is a safe and e ffective treatment for nonostial stenoses of the renal arteries, but i t has proved to be disappointing for ostial stenoses. Therefore, we pr ospectively studied the use of intravascular stents for the treatment of critical ostial stenoses after unsuccessful balloon angioplasty. Me thods Stainless-steel endoprostheses were placed across 74 renal-arter y stenoses located within 5 mm of the aortic lumen in 68 patients with hypertension. Twenty patients had mild or severe renal dysfunction. T he indications for stent placement were elastic recoil (63 arteries) o r dissection (1 artery) of the vessel after angioplasty, or restenosis after initially successful balloon angioplasty (10 arteries). Patient s were followed for a mean of 27 months with measurements of blood pre ssure and serum creatinine, duplex sonography, and intraarterial angio graphy. Results Initial technical success was achieved in all patients . Minor complications (local hematomas) occurred in only three patient s; there were no major complications. Eighty-four percent of the patie nts were free of primary occlusion 60 months after the procedure. Rest enosis of more than 50 percent of the vessel diameter occurred in 8 of 74 arteries (11 percent). Reintervention resulted in a secondary pate ncy rate of 92 percent. Long-term normalization of blood pressure was achieved in 11 patients (16 percent). Serum creatinine levels did not change significantly after successful stent implantation in patients w ith previously impaired renal function. Conclusions Accurate placement of renal-artery stents is technically feasible without major complica tions. The favorable early and long-term results suggest that primary stent placement is Bn effective treatment for renal-artery stenosis in volving the ostium. (C)1997, Massachusetts Medical Society.