Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
J Vasc Surg. 2010 Feb;51(2):380-5; discussion 385. doi: 10.1016/j.jvs.2009.08.088. Epub 2009 Nov 24.
Although technical success of renal artery stenting (RAS) is high and adverse events are infrequent, clinical success (improved blood pressure and renal function) and durability have been less predictable. Identifying those patients who will respond to RAS could improve overall outcomes of the procedure.
This was a retrospective analysis of all patients who underwent RAS for treatment of renovascular hypertension (RVH) between 2001 and 2007 at Dartmouth-Hitchcock Medical Center. The primary outcome measure was blood pressure improvement or cure as judged by American Heart Association criteria. Estimated glomerular filtration rate (eGFR), number of antihypertensive medications, and survival were evaluated as secondary outcomes. Univariate and multivariate analyses were performed to identify factors associated with blood pressure improvement at the last follow-up.
During the 6-year period, 129 patients (179 renal arteries) underwent stent placement for RVH. Procedural complications occurred nine patients (7.0%). Average length follow-up was 1.5 years. Follow-up data were obtained in 122 patients (95%). At last follow-up, there were significant improvements in systolic blood pressure (161 vs 144 mm Hg, P < .001), diastolic blood pressure (80 vs 73 mm Hg, P < .001), and number of antihypertensive medications (3.1 vs 2.8, P = .034). The eGFR was improved in 16% of patients, stable in 60%, and worse in 24%. By multivariate analysis, a baseline eGFR <40 mL/min/1.73 m2 (odds ratio, 1.6; 95% confidence interval [CI], 1.0-2.9; P = .02) and female gender (OR, 1.3; 95% CI, 1.0-2.1; P = .04) were independent predictors of failure to achieve blood pressure improvement. By 2 and 4 years of follow-up, sustained blood pressure improvement was present in 67% of patients with a baseline eGFR of > or = 40 mL/min/1.73 m2 and in 31% of patients with a baseline eGFR <40 mL/min/1.73 m2. During 2 years of follow-up, survival was similar between patients with sustained blood pressure response and those without.
Patients treated for RVH who have a baseline eGFR of > or = 40 mL/min/1.73 m2 demonstrate a better response to RAS at each follow-up interval, with a significant difference at 2 to 4 years, compared with patients with an eGFR <40 mL/min/1.73 m2.
尽管肾动脉支架置入术（RAS）的技术成功率很高，且不良事件很少发生，但临床成功率（血压和肾功能改善）和持久性一直难以预测。识别那些对 RAS 有反应的患者可以改善该手术的整体效果。
这是一项对 2001 年至 2007 年在达特茅斯-希区柯克医学中心接受 RAS 治疗肾血管性高血压（RVH）的所有患者进行的回顾性分析。主要观察指标为根据美国心脏协会标准判断的血压改善或治愈情况。作为次要观察指标，评估估算肾小球滤过率（eGFR）、降压药物数量和生存率。进行单变量和多变量分析，以确定与最后一次随访时血压改善相关的因素。
在 6 年期间，129 名患者（179 条肾动脉）接受了 RVH 的支架置入术。9 名患者（7.0%）发生了手术并发症。平均随访时间为 1.5 年。122 名患者（95%）获得了随访数据。最后一次随访时，收缩压（161 对 144mmHg，P<.001）、舒张压（80 对 73mmHg，P<.001）和降压药物数量（3.1 对 2.8，P=.034）均有显著改善。16%的患者 eGFR 改善，60%的患者 eGFR 稳定，24%的患者 eGFR 恶化。多变量分析显示，基线 eGFR<40mL/min/1.73m2（比值比，1.6；95%置信区间[CI]，1.0-2.9；P=0.02）和女性（比值比，1.3；95%CI，1.0-2.1；P=0.04）是血压改善失败的独立预测因素。在 2 年和 4 年的随访中，基线 eGFR≥40mL/min/1.73m2的患者中，有 67%的患者血压持续改善，而基线 eGFR<40mL/min/1.73m2的患者中，有 31%的患者血压持续改善。在 2 年的随访中，有持续血压反应的患者和无持续血压反应的患者的生存率相似。
对于接受 RVH 治疗的患者，与 eGFR<40mL/min/1.73m2的患者相比，基线 eGFR≥40mL/min/1.73m2的患者在每个随访间隔对 RAS 的反应更好，在 2 至 4 年的随访中差异显著。
