PRIMARY STENTING OF ATHEROSCLEROTIC RENAL-ARTERY OSTIAL STENOSIS

Percutaneous transluminal angioplasty for atherosclerotic ostial lesio ns of the renal arteries has resulted in high restenosis rates. Recent reports of angioplasty with intravascular stenting show improved resu lts over angioplasty alone. The purpose of this study is to review the results of primary stenting of ostial renal artery stenosis at our in stitution. Twenty one patients (11 men, 10 women, age 63 +/- 11 years) , with atherosclerotic renal artery ostial stenosis in association wit h hypertension or renal insufficiency underwent renal angioplasty with primary stenting during a 2-year period. Medical records were reviewe d for indications, technical success, complications, restenosis, respo nse of hypertension and response of renal insufficiency. A technical s uccess was defined as a normal postprocedure arteriogram with no resid ual stenosis and no residual gradient. Restenosis was defined as great er than or equal to 60% diameter reduction identified by arteriography , or duplex scan demonstrating a renal artery to aortic ratio of great er than or equal to 3.5. Thirty-three stents were placed in 25 arterie s with four patients having bilateral procedures. All patients were hy pertensive. Nine patients (43%) had chronic renal insufficiency (creat inine greater than or equal to 1.5 mg/dl). One patient was on hemodial ysis. The immediate technical success rate was 95%. Six complications occurred in four patients (two pseudoaneurysms, two dissections requir ing additional stents, renal failure, and atheroembolization). Mean ar terial blood pressure improved from 117 +/- 13.4 to 103 +/- 12.8 mmHg (p = 0.002) after stenting. Serum creatinine levels decreased from 1.4 8 +/- 0.57 to 1.31, 0.41 (p = 0.07). Eight patients developed restenos is. The mean follow up was 13 +/- 7 months. Life table analysis showed a cumulative restenosis rate of 65 +/- 18% at 24 months. We advise ca ution in the application of renal stenting for the treatment of ostial lesions, particularly in patients for whom standard surgical revascul arization options are available.