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Long-term follow-up after renal artery stenting

Langzeitergebnisse nach Nierenarterienstentimplantation

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Zusammenfassung

Hintergrund

Nierenarterienstenosen können sekundären arteriellen Bluthochdruck und Niereninsuffizienz verursachen. Die perkutane transluminale Stentangioplastie (PTRAS) ermöglicht eine effektive Behandlung mit einer hohen technischen Erfolgsrate. Diese Studie beschäftigt sich mit den morphologischen und klinischen Langzeitergebnissen anhand einer Kontrolluntersuchung. Hauptziele waren die Evaluierung der Restenoserate sowie die Überprüfung des arteriellen Blutdruckes und der Nierenfunktion.

Materialien und Methoden

40 Patienten, bei denen eine primär erfolgreiche PTRAS einer Nierenarterie durchgeführt wurde, wurden prospektiv eingeladen. Bei dieser Kontrolluntersuchung wurden eine Risikofaktorenerhebung, die Messung des arteriellen Blutdruckes sowie der Nierenfunktion und eine Multi-detector-Computer-tomographie-Angiographie durchgeführt (CTA).

Resultate

Die mediane Nachbeobachtungszeit betrug 3,3 Jahre. 67,5% der Patienten litten an Hyperlipidämie, 35% rauchten Zigaretten und 15% hatten Diabetes mellitus. Alle Patienten hatten Bluthochdruck, im Vergleich zur präinterventionellen Situation war die Blutdrucksituation jedoch noch bei 37,5% verbessert. Das Serumkreatinin war bei 25% der patienten erhöht, der mittlere Kreatininspiegel lag bei 1,3±0,4 mg/dl. Eine hämodynamisch relevante Restenose wurde von Untersucher 1 bei 5 Patienten und von Untersucher 2 bei 6 Patienten gefunden, was eine Restenoserate nach der medianen Nachbeobachtungszeit von 12,5% bzw. 15% ergibt. Beide Untersucher entdeckten weitere 3 hämodynamisch relevante Stenosen in den kontralateralen Nierenarterien.

Konklusion

PTRAS führt zu ausgezeichneten morphologischen Langzeitergebnissen, die klinischen Langzeitergebnisse basierend auf den Parametern arterielle Hypertonie und Nierenfunktion sind jedoch nur moderat. stage renal disease. Percutaneous transluminal angioplasty with stent implantation (PTRAS) allows effective and consistent treatment with a high technical success rate. The present trial focuses on the morphological and clinical results as assessed at a long-term follow-up (FU) visit. The main goals were assessment of the restenosis rate and evaluation of arterial hypertension and renal function.

Patients and methods

40 patients who had undergone successful stenting of a main renal artery were prospectively enrolled. At the FU visit, all patients underwent a risk-factor assessment, evaluation of arterial blood pressure and serum creatinine, and multi-detector computed tomography angiography (CTA).

Results

Median FU was 3.3 years. Hyperlipidemia was present in 67.5% of the patients, current cigarette smoking in 35% and diabetes mellitus in 15%. All patients still suffered from arterial hypertension but, compared with the pre-interventional situation, arterial hypertension was improved in 37.5%. Serum creatinine was increased in 25% of patients, mean creatinine level was 1.3±0.4 mg/dl. Hemodynamically relevant restenosis was detected by observer 1 in five patients and by observer 2 in six patients, giving restenosis rates of 12.5% and 15% respectively, after the median FU period. Both observers detected three additional relevant stenoses in the contralateral main renal arteries.

Conclusions

PTRAS gives excellent morphological long-term results. However, the clinical long-term outcome regarding arterial hypertension and renal function is only moderate.

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Authors and Affiliations

  1. Department of Angiography and Interventional Radiology, University Clinic for Radiology, Vienna, Austria

    Robert A. Bucek, Albert Dirisamer & Johannes Lammer

  2. Clinic for Internal Medicine II —Department of Angiology, General Hospital, Währinger Gürtel 18-20, A-1090, Wien, Austria

    Stefan Puchner, Markus Reiter & Erich Minar

Authors
  1. Robert A. Bucek
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  2. Stefan Puchner
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  3. Markus Reiter
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  4. Albert Dirisamer
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  6. Johannes Lammer
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Correspondence to Robert A. Bucek.

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Bucek, R.A., Puchner, S., Reiter, M. et al. Long-term follow-up after renal artery stenting. Wien Klin Wochenschr 115, 788–792 (2003). https://doi.org/10.1007/BF03040504

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  • DOI: https://doi.org/10.1007/BF03040504

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