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Selective stenting reduces BP in patients with renal artery stenosis
Patients with hypertension and renal artery stenosis due to Takayasu’s arteritis who were not responsive to percutaneous balloon angioplasty alone experienced reductions in BP when treated with selective stenting, according to recent results.
However, researchers noted that patients who received stents also had a lower rate of primary patency and higher rates of occlusion and reintervention at 2 years than patients who received angioplasty alone.
The retrospective analysis included data from 152 hypertensive patients with renal artery stenosis caused by Takayasu’s arteritis treated at a single hospital in Beijing between 2005 and 2012. The cohort was 75% female and the mean age was 31 years. Patients underwent percutaneous balloon angioplasty, with selective stenting performed among those with flow-limited dissection and/or residual stenosis of more than 50% of the diameter following angioplasty. Ninety-three patients received angioplasty alone in 115 renal arteries and 59 patients underwent stenting in 64 renal arteries.
Follow-up was conducted at 1, 6, 12, 18 and 24 months after treatment (median, 22.9 ± 4.2 months). Evaluated factors included primary and secondary patency, medication use and a composite of clinical events, including CV- or renal-related death, hospitalization due to congestive HF, MI, stroke, progressive renal insufficiency and need for permanent renal replacement therapy.
In the angioplasty group, stenosis decreased from 88.2% to 18.4% (P < .001) after treatment, whereas those in the stenting group experienced a stenosis reduction from 89.9% to 12.3% (P < .001). The two groups exhibited similar declines in systolic and diastolic BP, as well as in the number of hypertension medications used by patients, upon completion of follow-up. After 2 years, hypertension was considered cured in 27.4% of the angioplasty group and 22.4% in the stenting group; improved in 63.4% and 62.1% of patients, respectively; and unchanged in 12.3% and 15.5% of patients, respectively (P = .79).
The primary patency rate of 90.1% for renal artery lesions in the angioplasty group at 2 years vs. 75.6% for renal artery lesions in the stenting group (P = .008). Secondary patency rates at 2 years were 95.8% in the angioplasty group and 91.8% in the stent group; this difference was not significant.
Restenosis occurred in 14.4% of lesions during follow-up, with a higher restenosis rate observed in the stent group compared with the angioplasty group (23.8% vs. 9.6%; P = .01). Among those with restenosis, patients who received stenting experienced renal artery occlusion more frequently than those in the angioplasty group (53.3% vs. 8.3%; P = .019). Need for reintervention also was more common among stent recipients (13 vs. 8 patients; P = .003).
Factors associated with restenosis on Cox regression analysis included stenting (RR = 3.41; 95% CI, 1.58-7.37), active disease requiring treatment with steroids and/or immunosuppressants (RR = 3.32; 95% CI, 1.39-7.93); female sex (RR = 2.84; 95% CI, 1.28-6.29); and residual stenosis rate (RR = 1.04; 95% CI, 1.01-1.08.)
“When percutaneous transluminal angioplasty failed in correcting artery stenosis caused by Takayasu arteritis, selective stent placement had similar effects on [BP], renal function and clinical events as [angioplasty] alone did within 2 years’ follow-up period,” the researchers wrote. “It is important to [note] that stent placement, however, resulted in [a] lower 2-year primary patency rate, [a] higher occlusion rate and [a] higher reintervention rate compared with [angioplasty] alone.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.