RENAL-ARTERY STENT PLACEMENT FOR THE MANAGEMENT OF ISCHEMIC NEPHROPATHY

PURPOSE: To evaluate the angiographic and clinical results of percutan eously implanted renal artery endoprostheses (stents) for the treatmen t of patients with ischemic nephropathy, MATERIALS AND METHODS: During a 52-month period, 45 patients with azotemia (serum creatinine greate r than or equal to 1.5 mg/dL) and atheromatous renal artery stenosis u ntreatable by, or recurrent after, balloon angioplasty were treated by percutaneous placement of Palmaz stents, Stent implantation was unila teral in 32 cases and bilateral in 11 cases. Clinical results were det ermined by measurements of serum creatinine and follow-up angiography, Clinical benefit was defined as stabilization or improvement in serum creatinine level. Angiographic patency was defined as less than 50% d iameter recurrent arterial stenosis, RESULTS: Stent placement was tech nically successful in 51 of 54 (94%) renal arteries. Technical failure s were stent misdeployment requiring percutaneous stent retrieval (n = 2) and inadvertent placement distal to the desired position (n = 1), Complications included acute stent thrombosis (n 1) and early initiati on of hemodialysis (within 30 days; n = 1), There were two periprocedu ral deaths. With use of life-table analysis, clinical benefit was seen in 78% of patients at 6 months (n = 36), 72% at 1 year (n = 24), 62% at 2 years (n = 12), and 54% at 3 years (n = 3), In patients with clin ical benefit, average creatinine level was reduced from 2.21 mg/dL +/- 0.91 before treatment to 2.05 mg/dL +/- 1.05 after treatment (P = .01 8), Lower initial serum creatinine level was associated with a better chance of clinical benefit (P = .05), No other variables affected outc ome, including patient age, sex, diabetes, implanted stent diameter, u nilateral versus bilateral stent placement, or ostial versus nonostial stent positioning. Conventional catheter angiography or spiral comput ed tomographic (CT) angiography performed in 19 patients (28 stents) a t a mean interval of 12.5 months demonstrated primary patency in 75%, Maintained stent patency appeared to correlate with renal functional b enefit. CONCLUSIONS: Percutaneous renal artery stent placement for ang ioplasty failures or restenoses provides clinical benefit in most pati ents with ischemic nephropathy.