Department of Nephrology, Heraklion University Hospital, Crete, Greece.
Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA.
J Clin Hypertens (Greenwich). 2018 Feb;20(2):373-381. doi: 10.1111/jch.13160. Epub 2018 Jan 6.
The authors evaluated the effectiveness of percutaneous renal revascularization (PRR) with stenting for the treatment of atherosclerotic renal artery stenosis (ARAS) in patients with coronary artery disease and the usefulness of captopril renal scintigraphy for predicting clinical outcomes after PRR. Sixty-four consecutive patients, referred for evaluation of suspected ARAS, after coronary angiography, underwent baseline captopril renal scintigraphy followed by renal angiography. Forty-four patients (68.7%) were diagnosed with a significant ARAS≥ 60% and were treated with PRR plus medical therapy. Twenty-four months after PRR, 86.4% and 73.3% of patients showed a hypertension and renal benefit, respectively. Captopril renal scintigraphy positivity had moderate sensitivity and high specificity in predicting a hypertension and renal benefit. In patients with ARAS≥ 70%, the sensitivity and specificity were 100% for both a hypertension and renal benefit.PRR for ARAS conferred a substantial benefit in patients with a high coronary artery disease burden. Captopril renal scintigraphy was highly accurate in predicting clinical outcomes.
作者评估了经皮肾血管成形术（PRR）联合支架置入治疗冠心病合并动脉粥样硬化性肾动脉狭窄（ARAS）的疗效，以及卡托普利肾闪烁显像术预测 PRR 后临床结果的作用。64 例连续患者在冠状动脉造影后因疑似 ARAS 而接受评估，行基线卡托普利肾闪烁显像术，然后行肾血管造影术。44 例（68.7%）患者被诊断为狭窄程度≥60%的显著 ARAS，并接受 PRR 加药物治疗。PRR 后 24 个月，86.4%和 73.3%的患者分别出现高血压和肾脏受益。卡托普利肾闪烁显像术阳性对预测高血压和肾脏受益具有中等敏感性和高度特异性。在 ARAS≥70%的患者中，高血压和肾脏受益的敏感性和特异性均为 100%。PRR 治疗 ARAS 可使高冠心病负担患者获得显著获益。卡托普利肾闪烁显像术对预测临床结果具有高度准确性。
