Management of renovascular disease: a review of renal artery stenting in ten studies

To evaluate the efficacy and safety of renal artery stents in renovascular disease, we identified 10 descriptive studies containing sufficient informa tion for systematic evaluation. No randomized comparisons of stenting with angioplasty or with surgery were found. Overall, stents were placed in 416 renal arteries in 379 patients, mean age 64 years (range 27-84), 56% male. Of the stenoses, 97% were atheromatous (inter-study range 71-100%), 80% ost ial (22-100%) and 31% bilateral (12-87%). The clinical indication for stent ing was usually hypertension with or without mild renal impairment. Radiolo gical indications for stenting were: narrowing of greater than or equal to 50% (in 9/10 studies) as a result of elastic recoil (58%) or dissection (2% ) at the time of angioplasty; restenosis some time after angioplasty (15%); or as a primary procedure (25%). Technical success was reported in 96-100% of procedures. Restenosis (greater than or equal to 50% narrowing), evalua ted in 312/416 (75%) arteries, generally between 6 and 12 months, was 16% o verall. Hypertension was cured by stenting (DBP less than or equal to 90 mm Hg on no treatment) in 34/379 (9%) overall and in 34/207 (16%) of those who se renal function was normal initially. Six of 379 (1.6%) patients died wit hin 30 days of stenting, but in only two (0.5%) was death judged to be proc edure-related. Complications, other than those which led to dialysis, occur red in 42/379 (13%) patients, one third requiring intervention, ranging fro m blood transfusion to a surgical bypass procedure. Renal function as judge d by serum creatinine concentration (SCC) improved in 26%, stabilized in 48 % and deteriorated in 26% of patients whose renal function was impaired ini tially (SCC >133 mu mol/l). In one study, with average baseline SCC >200 mu mol/l, successful stenting slowed the rate of progression of renal failure when renal function was deteriorating beforehand. Nine of 379 (2.4%) patie nts, including 7/14 (50%) whose SCC was greater than or equal to 400 mu mol /l initially, required dialysis after stenting. Stenting should be offered by specialist centres as a secondary procedure for unsuccessful angioplasty , or restenosis following angioplasty, to patients with renovascular diseas e and uncontrolled hypertension, advancing renal failure or pulmonary oedem a.