Endovascular revascularization of renal artery stenosis in the solitary functioning kidney

The treatment of renal artery stenosis by angioplasty and stenting is an ef fective and accepted alternative to surgery for the treatment of renovascul ar hypertension and preservation of renal function. We report the technical and clinical outcomes of renal artery stenting in patients with a solitary functioning kidney and renal artery stenosis. From October 1993 to Novembe r 1999, 30 stents were placed in the renal arteries of 27 patients (mean ag e 72 +/- 8 years) with a solitary functioning kidney and azotemia. The mean diameter renal artery stenosis was 86 +/- 14%. The mean preprocedure serum creatinine (Cr) revel was 3.0 +/- 1.5 mg/dL (range 1.5-7.5 mg/dL), arteria l blood pressure was 171 +/- 29/85 +/- 13 mmHg, and the number of antihyper tensive drugs was 2.9 +/- 1.1. Indications for stenting were suboptimal bal loon dilation (n = 16), intimal dissection (n = 6), and restenosis followin g angioplasty (n = 5). Atherosclerotic ostial lesions were present in 25 (9 3%) of 27 renal arteries. This represents the largest series of renal arter y stenting in patients with a solitary functioning kidney, and demonstrates this treatment modality to be a relatively safe alternative to conventiona l surgery in this high-risk patient group. Most (74%) of the patients in th is series had improved or stabilized renal function. Further efforts to def ine preprocedural indicators of success are necessary to identify the patie nts who may benefit from revascularization of their solitary kidney.