Henry M, Henry I, Polydorou A, Polydorou A D, Hugel M
80 rue Raymond Poincaré, Nancy, France.
J Cardiovasc Surg (Torino). 2007 Aug;48(4):411-42.
Renal artery stenosis (RAS) is frequent and increasingly recognized thanks to technical improvements in duplex ultrasound, magnetic resonance angiography, computed tomography (CT) scanning, systematic renal angiography during cardiac catheterisation, coronary procedures and particularly in hypertensive or multivascular diseased patients. Renal artery angioplasty and stenting is the first treatment to be proposed for patients suffering from RAS. This procedure is largely performed with very good technical results, good anatomical results, a low complication rate and a good long-term patency. The technique has proven to be beneficial for preserving RF and stabilizing or improving BP in a large number of patients. Nevertheless, deterioration in RF after the procedure in 20-30% of cases may limit the immediate benefits of this technique. Atheroembolism seems to play an important role. Renal angioplasty with protection devices seems a promising technique that might become the standard of care in the future. Even so, some problems remain: the cost of the technique; the best protection device needs to be determined; protection devices specifically designed for the renal arteries are needed; indications have to be specified. Larger, randomised studies are awaited to confirm the usefulness of the technique.
由于双功超声、磁共振血管造影、计算机断层扫描（CT）、心脏导管插入术期间的系统性肾血管造影、冠状动脉手术，特别是在高血压或多血管疾病患者中技术的改进，肾动脉狭窄（RAS）越来越常见且得到了更多的认识。肾动脉血管成形术和支架置入术是针对RAS患者首先推荐的治疗方法。该手术在很大程度上技术效果良好，解剖学效果良好，并发症发生率低且长期通畅率良好。该技术已被证明对大量患者保留肾功能（RF）以及稳定或改善血压有益。然而，在20% - 30%的病例中，术后肾功能会恶化，这可能会限制该技术的直接益处。动脉粥样硬化栓塞似乎起着重要作用。带有保护装置的肾血管成形术似乎是一种有前景的技术，未来可能会成为标准治疗方法。即便如此，仍存在一些问题：该技术的成本；需要确定最佳保护装置；需要专门为肾动脉设计的保护装置；必须明确适应症。期待更大规模的随机研究来证实该技术的有效性。
