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Restenosis Rates After Drug-Eluting Stent Treatment for Stenotic Small-Diameter Renal Arteries

Abstract

Purpose

To determine primary rates in small-diameter renal arteries, including complex bifurcation lesions, treated with drug-eluting stents (DES) in patients with atherosclerotic renal artery stenosis.

Materials and Methods

This is a retrospective single-institution study. A total of 37 patients with 39 stented renal arteries were included. Patient and procedural data were obtained from the electronic medical record. Survival free from restenosis was estimated using the Kaplan–Meier method with patients stratified into two groups based on renal artery diameters (≤ 3.5 mm or > 3.5 mm). Univariate Cox proportional models were used to estimate hazard ratios associated with clinical and angiographic variables.

Results

Average renal artery diameter at time of treatment was 3.4 mm ± 0.4 mm. The median survival free from restenosis was 992 days, with 11 out of 37 (29.7%) developing an in-stent restenosis. Renal arteries < 3.5 mm in diameter had similar patency rates as renal arteries > 3.5 mm (P = 0.33). The 1-, 2-, and 5-year patency rates were 71%, 63%, and 38%, respectively. History of stroke was the only comorbidity to portend a significantly greater rate of restenosis (hazard ratio 3.77; 95%CI, 1.05–13.6; P = 0.04). Medications did not statistically alter the risk of restenosis.

Conclusion

Revascularization of renal arteries with DES achieved similar primary patency rates irrespective of renal artery diameter. Stent configuration was not associated with time to renal replacement therapy or all-cause mortality.

Level of Evidence

Level 3, Cohort Study.

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References

  1. 1.

    Lao D, Parasher PS, Cho KC, Yeghiazarians Y. Atherosclerotic renal artery stenosis—diagnosis and treatment. Mayo Clin Proc. 2011;86(7):649–57. https://doi.org/10.4065/mcp.2011.0181.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Herrmann SM, Saad A, Textor SC. Management of atherosclerotic renovascular disease after cardiovascular outcomes in renal atherosclerotic lesions (CORAL). Nephrol Dial Transplant. 2015;30(3):366–75. https://doi.org/10.1093/ndt/gfu067.

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Vassallo D, Kalra P. Atherosclerotic renovascular disease—epidemiology, treatment and current challenges. Postep Kardiol Inter. 2017;13(3):191–201. https://doi.org/10.5114/aic.2017.70186.

    Article  Google Scholar 

  4. 4.

    Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA task force on practice guidelines (writing committee to develop guidelines for the Management of Patients with Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; Trans Atlantic inter-society consensus; and vascular disease foundation. Circulation. 2006;113:e463–654. https://doi.org/10.1161/circulationaha.106.174526.

    Article  Google Scholar 

  5. 5.

    Zeller T, Rastan A, Rothenpieler U, Muller C. Restenosis after stenting of atherosclerotic renal artery stenosis: is there a rationale for the use of drug-eluting stents? Catheter Cardiovasc Interv. 2006;68(1):125–30. https://doi.org/10.1002/ccd.20773.

    Article  PubMed  Google Scholar 

  6. 6.

    Takahashi EA, McKusick MA, Bjarnason H, Piryani A, Harmsen WS, Misra S. Treatment of in-stent restenosis in patients with renal artery stenosis. J Vasc Interv Radiol. 2016;27(11):1657–62. https://doi.org/10.1016/j.jvir.2016.05.041.

    Article  PubMed  Google Scholar 

  7. 7.

    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med. 1999;130(6):461–70.

    Article  CAS  Google Scholar 

  8. 8.

    Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease.

  9. 9.

    Cain BC, Wuamett JC, Soult M, Larion S, Ahanchi S, Panneton JM. Duplex ultrasound criteria for renal artery in-stent restenosis. J Vasc Surg. 2016;64(5):1548. https://doi.org/10.1016/j.jvs.2016.08.048.

    Article  Google Scholar 

  10. 10.

    Misra S, Thatipelli MR, Howe PW, Hunt C, Mathew V, Barsness GW, et al. Preliminary study of the use of drug-eluting stents in atherosclerotic renal artery stenoses 4 mm in diameter or smaller. J Vasc Interv Radiol. 2008;19(6):833–9. https://doi.org/10.1016/j.jvir.2008.03.017.

    Article  PubMed  Google Scholar 

  11. 11.

    Misra S, Sturludottir M, Mathew V, Bjarnason H, McKusick M, Iyer VK. Treatment of complex stenoses involving renal artery bifurcations with use of drug-eluting stents. J Vasc Interv Radiol. 2008;19(2 Pt 1):272–8. https://doi.org/10.1016/j.jvir.2007.10.028.

    Article  PubMed  Google Scholar 

  12. 12.

    Palmerini T, Benedetto U, Biondi-Zoccai G, Della Riva D, Bacchi-Reggiani L, Smits PC, et al. Long-term safety of drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol. 2015;65(23):2496–507. https://doi.org/10.1016/j.jacc.2015.04.017.

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Stefanini GG, Holmes DR Jr. Drug-eluting coronary-artery stents. N Engl J Med. 2013;368(3):254–65. https://doi.org/10.1056/NEJMra1210816.

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Sapoval M, Zahringer M, Pattynama P, Rabbia C, Vignali C, Maleux G, et al. Low-profile stent system for treatment of atherosclerotic renal artery stenosis: the GREAT trial. J Vasc Interv Radiol. 2005;16(9):1195–202. https://doi.org/10.1097/01.rvi.0000171765.67665.d3.

    Article  PubMed  Google Scholar 

  15. 15.

    Bradaric C, Eser K, Preuss S, Dommasch M, Wustrow I, Langwieser N, et al. Drug-eluting stents versus bare metal stents for the prevention of restenosis in patients with renovascular disease. EuroIntervention. 2017;13(2):e248–55. https://doi.org/10.4244/eij-d-16-00697.

    Article  PubMed  Google Scholar 

  16. 16.

    Lederman RJ, Mendelsohn FO, Santos R, Phillips HR, Stack RS, Crowley JJ. Primary renal artery stenting: characteristics and outcomes after 363 procedures. Am Heart J. 2001;142(2):314–23. https://doi.org/10.1067/mhj.2001.116958.

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Puymirat E, Mangiacapra F, Peace A, Sharif F, Conte M, Bartunek J, et al. Long-term clinical outcome in patients with small vessel disease treated with drug-eluting versus bare-metal stenting. Am Heart J. 2011;162(5):907–13. https://doi.org/10.1016/j.ahj.2011.07.024.

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med. 2014;370(1):13–22. https://doi.org/10.1056/NEJMoa1310753.

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Wheatley K, Ives N, Gray R, Kalra PA, Moss JG, Baigent C, et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med. 2009;361(20):1953–62. https://doi.org/10.1056/NEJMoa0905368.

    Article  PubMed  Google Scholar 

  20. 20.

    Misra S, Khosla A, Allred J, Harmsen WS, Textor SC, McKusick MA. Mortality and renal replacement therapy after renal artery stenting for atherosclerotic renovascular disease. J Vasc Interv Radiol. 2016;27(8):1215–24. https://doi.org/10.1016/j.jvir.2016.05.001.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Dorros G, Jaff M, Mathiak L, He T. Multicenter Palmaz stent renal artery stenosis revascularization registry report: four-year follow-up of 1,058 successful patients. Catheter Cardiovasc Interv. 2002;55(2):182–8.

    Article  PubMed  Google Scholar 

  22. 22.

    Kennedy DJ, Colyer WR, Brewster PS, Ankenbrandt M, Burket MW, Nemeth AS, et al. Renal insufficiency as a predictor of adverse events and mortality after renal artery stent placement. Am J Kidney Dis. 2003;42(5):926–35.

    Article  PubMed  Google Scholar 

  23. 23.

    Takahashi EA, Kallmes DF, Fleming CJ, McDonald RJ, McKusick MA, Bjarnason H, et al. Predictors and outcomes of postcontrast acute kidney injury after endovascular renal artery intervention. J Vasc Interv Radiol. 2017;28(12):1687–92. https://doi.org/10.1016/j.jvir.2017.07.038.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Wallace EL, Tasan E, Cook BS, Charnigo R, Abdel-Latif AK, Ziada KM. Long-term outcomes and causes of death in patients with renovascular disease undergoing renal artery stenting. Angiology. 2016;67(7):657–63. https://doi.org/10.1177/0003319715609013.

    Article  PubMed  Google Scholar 

  25. 25.

    Colyer WR Jr, Cooper CJ. Cardiovascular morbidity and mortality and renal artery stenosis. Prog Cardiovasc Dis. 2009;52(3):238–42. https://doi.org/10.1016/j.pcad.2009.09.004.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

SM has funding from National Institutes of Health Grant DK107870 from the National Heart, Lung, and Blood Institute (HL 098967)

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Correspondence to Sanjay Misra.

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The authors declare that they have no conflict of interest.

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This study has obtained IRB approval from the Mayo Clinic IRB committee, and the need for informed consent was waived.

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Jundt, M.C., Takahashi, E.A., Harmsen, W.S. et al. Restenosis Rates After Drug-Eluting Stent Treatment for Stenotic Small-Diameter Renal Arteries. Cardiovasc Intervent Radiol 42, 1293–1301 (2019). https://doi.org/10.1007/s00270-019-02264-z

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Keywords

  • Drug-eluting stent
  • Renal artery stenosis
  • Renal replacement therapy