Purpose: To evaluate the clinical outcomes of patients undergoing renal art
ery stenting with intravascular ultrasound (IVUS) guidance and compare meas
urements between IVUS and angiography.
Methods: One hundred thirty-one patients (71 women; mean age 71 +/-8 years)
underwent IVUS-guided Palmaz stent implantation in 153 stenotic renal arte
ries at a single center. The indications for stenting were uncontrolled hyp
ertension (102, 77.9%), renal insufficiency (10, 7.6%), and both conditions
(19, 14.5%). The majority of lesions were ostial (114, 74.5%); the remaind
er occupied the proximal renal artery (39, 25.5%). The mean lesion length a
nd diameter stenosis were 6.5 +/-3.0 mm and 74%+/- 10%, respectively, as me
asured by angiography. Data were recorded in a prespecified database; angio
graphic and IVUS images were analyzed at dedicated core laboratories and co
mpared.
Results: Angiographic success was achieved in all patients, but IVUS indica
ted the need for additional intervention in 36 (23.5%) cases. There was str
ong correlation between the angiographic and IVUS measurements of lesion le
ngth (r = 0.60, p < 0.0001) and pre-/postprocedural minimal luminal diamete
r (r = 0.72 and 0.63, respectively; p < 0.0001). The mean contrast volume w
as 74 +/- 18 mL per case. In-hospital renal failure occurred in 8 (6.1%) pa
tients; 2 (1.5%) required transient hemodialysis. At a mean 15-month follow
-up, patients were treated with fewer anti hypertensive medications (p = 0.
05), and systolic and diastolic arterial blood pressures had decreased (p =
0.001); no significant change was noted in serum creatinine.
Conclusions: IVUS-guided stenting facilitates safe renal artery revasculari
zation. IVUS imaging may complement angiography in certain cases, which sho
uld be studied further in prospective studies with iodinated or noniodinate
d contrast agents.