Prevention of recurrent pulmonary edema in patients with bilateral renovascular disease through renal artery stent placement

Pulmonary edema and congestive heart failure (both referred to here as PE) have been reported to be complications of bilateral renal artery stenosis o r unilateral stenosis in a solitary functioning kidney (both referred to as BRAS). The goals of this study were to determine whether a history of PE w as more common in patients with BRAS than in those with unilateral stenosis and a normal contralateral kidney (URAS), and whether recurrent PE could b e prevented by renal artery stent placement. We evaluated 90 consecutive patients with renovascular disease who were tre ated with percutaneous renal artery stent placement. History and clinical f ollow-up were obtained through chart review and phone contact with referrin g physicians. Mean follow-up was 18.4 months after stent placement. Twenty- three of 56 (41%) subjects with BRAS had a history of PE before revasculari zation, compared with four of 34 (12%) subjects with URAS (P = .05). Twenty -five of the 27 patients with history of PE had adequate clinical follow-up . Seventeen of the 22 (77%) subjects with BRAS and history of PE had no fur ther PE after stent placement in one or both renal arteries. The five BRAS subjects with recurrent PE after stent placement had evidence of stent thro mbosis or restenosis. In contrast, only one of three (33%) URAS subjects wi th a history of PE remained free of PE after stent placement. We conclude t hat PE is a common complication of BRAS, but not of URAS. In patients with BRAS, recurrent PE can be prevented by successful stent placement in one or both renal arteries. (C) 1999 American Journal of Hypertension, Ltd.