Department of Radiology, La Timone Hospital, Marseille, France.
Department of Hypertension and Vascular Medicine, La Timone Hospital, Marseille, France.
J Vasc Surg. 2022 Mar;75(3):939-949.e1. doi: 10.1016/j.jvs.2021.09.023. Epub 2021 Sep 30.
The indication of percutaneous renal transluminal angioplasty (PTRA) in fibromuscular dysplasia (FMD) is mainly based on renal artery stenosis (RAS) due to atherosclerosis criteria, which are not specific to FMD. Consequently, the selection of patients who could benefit from this treatment and its effectiveness remain uncertain. The aims of this study were to: (1) report the effects of PTRA guided by trans-stenotic pressure measurements on hypertension 7 months after treatment; (2) assess the impact of pressure measurement to guide treatment efficacy in comparison to visual angiographic parameters; and (3) evaluate the reproducibility and accuracy of the stenosis measurement using a 4F catheter in comparison to a pressure guidewire.
This prospective multi-centric study analyzed 24 patients with hypertension with RAS due to FMD that required PTRA. Clinical, duplex ultrasound, and angiographic indices were collected, and patients were followed up for 7 months (±1 month). Angiographic indices were measured twice both by a pressure guidewire and a 4F catheter. Assessment of procedural and clinical success of angioplasty was performed for all patients.
Twenty-three patients (96%) had procedural success (considered as a post-PTRA translesional systolic gradient ≤10 mmHg or reduced by at least 80%) with a significant decrease in the systolic gradient after angioplasty (26.50 mmHg; [interquartile range, 16.75-38.75] vs 0.00 [interquartile range, 0.00-2.00]; P < .01). Three patients (12%) had complications, including two renal artery dissections and one partial renal infarction. Twenty-one patients (88%) were clinical responders to angioplasty at follow-up. Visual stenosis assessment showed a poor correlation with systolic gradient measurement before and after PTRA (R from -0.05 to 0.41; P = 0.06-0.82). High correlations were found between pressure measurements made by a 4F catheter and guidewire (R from 0.64 to 0.89; P ≤ .003).
In patients selected by clinical indicators and duplex ultrasound, reaching a translesional systolic gradient ≤10 mmHg or reduced by at least 80% after angioplasty, promotes a high success rate for PTRA in hypertension due to FMD RAS.
经皮肾腔内血管成形术（PTRA）在纤维肌性发育不良（FMD）中的适应证主要基于动脉粥样硬化标准的肾动脉狭窄（RAS），但这些标准对 FMD 并不特异。因此，哪些患者可能从这种治疗中获益以及治疗效果如何仍然不确定。本研究的目的是：（1）报告经跨狭窄段压力测量指导的 PTRA 对治疗后 7 个月高血压的影响；（2）评估压力测量与视觉血管造影参数指导治疗效果的相关性；（3）评估与压力导丝相比，使用 4F 导管测量狭窄程度的可重复性和准确性。
这项前瞻性多中心研究纳入了 24 例因 FMD 导致 RAS 而需要 PTRA 的高血压患者。收集临床、双功能超声和血管造影指数，并对患者进行 7 个月（±1 个月）的随访。用压力导丝和 4F 导管两次测量血管造影指数。对所有患者的血管成形术的程序和临床成功率进行评估。
23 例患者（96%）获得了程序成功（定义为经皮腔内血管成形术后跨狭窄段收缩期梯度≤10mmHg 或降低至少 80%），血管成形术后收缩期梯度显著降低（26.50mmHg；[四分位距，16.75-38.75] vs 0.00mmHg；[四分位距，0.00-2.00]；P<0.01）。3 例患者（12%）发生并发症，包括 2 例肾动脉夹层和 1 例部分肾梗死。21 例患者（88%）在随访时对血管成形术有临床反应。血管造影评估的狭窄程度与 PTRA 前后的收缩期梯度测量值相关性较差（R 从-0.05 到 0.41；P=0.06-0.82）。用 4F 导管和导丝测量的压力之间存在高度相关性（R 从 0.64 到 0.89；P≤0.003）。
在根据临床指标和双功能超声选择的患者中，经血管成形术后跨狭窄段收缩期梯度≤10mmHg 或降低至少 80%，可显著提高因 FMD 引起的 RAS 高血压患者的 PTRA 成功率。
