Stents in the treatment of renal artery stenosis: Long-term follow-up

Purpose: To evaluate the role of percutaneous stenting in the treatment of renal arterial lesions after failure of balloon angioplasty. Methods: Two hundred ten patients (139 mates; mean age 67.7 +/- 9.9 years, range 27 to 87) had 259 balloon-expandable stents (165 Palmaz and 94 Renal Bridge stents) implanted in 244 renal artery stenoses (171 ostial and 73 no nostial lesions). The patients were suffering from intractable hypertension (n = 210) and/or renal dysfunction (n = 48). The majority of the lesions ( n = 234) were atheromatous in origin. Stents were implanted for suboptimal balloon dilation (n = 182, 75%), restenotic lesions (n = 27, 11%), or disse ction (n = 9, 4%); 26 (11%) ostial lesions were stented primarily. Mean les ion length was 11.9 +/- 4.4 mm (range 5 to 30) and mean percent stenosis wa s 81.9% +/- 8.25% (range 70 to 100). Results: Immediate technical success was 99% (241 of 244). Three (1.2%) maj or complications included one intraprocedural stent thrombosis, one arteria l perforation manifesting as a perirenal hematoma 24 hours after the proced ure, and one renal arterial rupture. Follow-up over a mean 25.4 +/- 22.8 months (range 1 to 96) in 185 eligible patients (209 arteries) found 24 cases of restenosis (11.4%). Primary and s econdary patencies for all lesions at 60 months were 79% and 98%, respectiv ely, with no significant differences between ostial and nonostial lesions o r stent types. Hypertension was reversed in 35 (19%), improved in 112(61%), and remained unchanged in 37 (20%). Renal function was improved in 29% (14 of 48), unchanged in 67% (32 of 48), and worse in 4% (2 of 48). Conclusions: Renal artery stenting is safe, effective, and may be an altern ative to surgery, particularly in ostial lesions. Our experience shows redu ction in the restenosis rate compared to conventional angioplasty. All osti al stenoses should be stented.