The efficacy of renal artery stent combined with optimal medical therapy in patients with severe atherosclerotic renal artery stenosis.

OBJECTIVE

To evaluate the efficacy of renal artery stent combined with optimal medical therapy as treatment for renal artery stenosis.

RESEARCH DESIGN AND METHODS

A prospective cohort study was conducted. Patients with severe atherosclerotic renal artery stenosis received percutaneous renal artery stent because of poorly controlled hypertension or preservation of renal function. The patients also received optimal medical therapy to achieve the blood pressure, lipid and blood glucose targets.

MAIN OUTCOME MEASURES

All patients underwent a 12 month follow-up to observe the effect of the procedure on blood pressure control, number of antihypertensive medications and creatinine level.

RESULTS

Stents were placed in 185 renal arteries of 149 patients. Mean stenosis was 83.1 ± 7.0%. The success rate of renal artery stent was 99.3%. At 12 months, estimated glomerular filtration rate increased significantly compared with baseline (84.1 ± 28.8 vs. 76.5 ± 22.50 ml/min ×1.73 m, p < 0.05). Both office blood pressure and 24 hour blood pressure significantly decreased compared with baseline (from 153/83 mmHg to 134/73 mmHg and from 143/80 mmHg to 124/69 mmHg, respectively; p < 0.05), and less antihypertensive medication was taken compared with baseline (1.5 ± 0.8 vs. 2.2 ± 0.9; p < 0.05).

CONCLUSIONS

Renal artery stent combined with optimal medical therapy as a treatment has a beneficial effect on blood pressure control and estimated glomerular filtration rate in selected patients with atherosclerotic renal artery stenosis. Larger studies with a longer follow-up appear necessary to further confirm these intriguing findings.