Long-term effects of arterial stenting on kidney function for patients with ostial atherosclerotic renal artery stenosis and renal insufficiency

It is uncertain whether renal artery stent placement in patients with ather osclerotic renovascular renal failure can prevent further deterioration of renal function. Therefore, the effects of renal artery stent placement, fol lowed by patency surveillance, were prospectively studied in 63 patients wi th ostial atherosclerotic renal artery stenosis and renal dysfunction (i.e. , serum creatinine concentrations of >120 mu mol/L (median serum creatinine concentration, 171 mu mol/L; serum creatinine concentration range, 121 to 650 mu mol/L). Pre-stent renal (dys) function was stable for 28 patients an d declining for 35 patients (defined as a serum creatinine concentration in crease of greater than or equal to 20% in 12 mo). The median follow-up peri od was 23 mo (interquartile range, 13 to 29 mo). Angioplasty to treat reste nosis was performed in 12 cases. Five patients reached end-stage renal fail ure within 6 mo, and this was related to stent placement in two cases. Two other patients died or were lost to follow-up monitoring within 6 mo, with stable renal function. For the remaining 56 patients, the treatment had no effect on serum creatinine levels if function had previously been stable; i f function had been declining, median serum creatinine concentrations impro ved in the first 1 yr [from 182 mu mol/L (135 to 270 mu mol/L) to 154 mu mo l/L (127 to 225 mu mol/L); P < 0.05] and remained stable during further fol low-up monitoring. In conclusion, stent placement, followed by patency surv eillance, to treat ostial atherosclerotic renal artery stenosis can stabili ze declining renal function. For patients with stable renal dysfunction, th e usefulness is less clear. The possible advantages must be weighed against the risk of renal failure advancement with stent placement.