Renal artery angioplasty and stent placement: Predictors of a favorable outcome

Background Renal artery stenosis is a common disorder and is an established cause of hypertension and renal insufficiency. Although treatment with ren al artery stents has been shown to improve blood pressure and renal functio n for some patients, the patient population most likely to benefit is unkno wn. The current study was designed to determine which factors are predictiv e of improved blood pressure and renal function when patients with renal ar tery stenosis are treated with renal artery angioplasty and stent placement . Methods In a prospective evaluation 127 consecutively enrolled patients wit h renal artery stenosis in 171 vessels were treated with angioplasty and in travascular stents. Brood pressure and serum creatinine concentration were measured before stent placement and during the follow-up period. Results The mean length of the follow-up period was 15 +/- 14 months. Mean systolic blood pressure improved among patients with hypertension (from 177 +/- 26 mm Hg before stent placement to 151 +/- 24 mm Hg 6 months after ste nt placement (P < .001). The greatest improvement occurred among those with the highest baseline systolic blood pressure. This beneficial effect on bl ood pressure was sustained for 3 years. Sex, age, diastolic blood pressure, number of vessels into which stents were placed, serum creatinine concentr ation, presence of bilateral disease, race, and severity of stenosis were n ot predictive of improved blood pressure. Mean creatinine concentration was not significantly changed for the group as a whole. A significant decrease in serum creatinine concentration occurred among 43% of patients with base line renal insufficiency. None of the examined variables was predictive of improvement. Conclusions Renal artery angioplasty and stent placement produced a signifi cantly greeter reduction in systolic blood pressure among patients with the highest baseline systolic blood pressure. Other examined variables were no r predictive of a significant improvement in blood pressure. No examined va riable was predictive of improved renal function. We concluded that managem ent of renal artery stenosis with renal artery angioplasty and stent placem ent is most likely to result in significant improvement in systolic blood p ressure among patients with the highest baseline systolic blood pressure.