Clinical efficacy of percutaneous renal revascularization with stent placement in hypertension among patients with atherosclerotic renovascular diseases.

AIM

The aim was to assess the effect of renal angioplasty with stent on systolic, diastolic, and mean arterial blood pressure (MAP) in awake and sleep time with ambulatory blood pressure (ABP) monitoring (Holter monitoring).

MATERIALS AND METHODS

Patients with angiographically proven atherosclerotic renal artery stenosis (RAS) were referred to the Angiography Department of Imam Hospital for intervention during a 1-year period from June 2008 to December 2009. Primary stent placement was attempted by a single operator in 27 severe RAS cases although 1 case was omitted from the study because of technical failure. Pre- and postprocedure creatinine levels, ejection fraction (EF), history of diabetes mellitus (DM), and ABP were obtained. Twenty-six (17 men, 9 women; average age, 62.6 years; age range, 90-21 years) consecutive patients participated in the study.

RESULTS

All patients had severe hypertension resistant to multiple medications; 10 patients had impaired renal function (serum creatinine level greater than 130 µmol/L). A total of 3 (11.5%) patients had congestive heart failure, and 10 (37.7%) were diabetic. Hypertension was cured in 1 (4%) patient, had improved in 23 (88.4%) patients, and had failed to respond to treatment in 2 (7.6%). Serum creatinine decreased significantly from 1.46 ± 0.89 to 1.35 ± 0.61 mg/dL (P<0.05).

CONCLUSION

Percutaneous transluminal angioplasty for atheromatous RAS rarely cures hypertension, but improved blood pressure control is often achieved.