Department of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Hypertens Res. 2023 Jun;46(6):1407-1416. doi: 10.1038/s41440-023-01216-y. Epub 2023 Feb 10.
To date, few study has defined the exact role or utility of intravascular ultrasound (IVUS) in the diagnosis and treatment of renal artery fibromuscular dysplasia (FMD). We investigated whether using an IVUS would provide additional insights in the hypertensive patients with focal renal artery FMD. A prospective, observational study, including all patients with focal renal artery FMD admitted to the Ruijin hospital during 6 consecutive years (2015-2021). Based on IVUS imaging, focal FMD patients were classified as two subtypes: intima-media thickening (IMT) and negative remodeling (NR) of the whole vessel. A total of 36 consecutive patients (24 ± 7, 13-39 years) with focal renal artery FMD were enrolled. Angiographic unifocal type was present in 22 (61.1%) patients and tubular type was present in 14 (38.9%) patients. Among 22 patients with unifocal, IVUS showed that 18 (81.8%) had IMT and 4 (18.2%) had NR. 14 patients with tubular, IVUS showed 3 (21.4%) had IMT and 11 (78.6%) had NR. No difference in age of onset, gender, BMI, initial BP levels were found between IMT and NR subtypes. However, hypertension cure rates of short-term (48 h after angioplasty) (76.2% vs. 26.7%, p = 0.004) and long-term (1-6years) (90.5% vs. 20.0%, p < 0.001) were higher in patients with IMT than in those with NR subtype. In present study, we described a new classification of focal renal artery FMD into IMT or NR subtype based on IVUS. Renal FMD Patients with IMT subtype were more likely to achieve cure of hypertension. We investigated whether using an IVUS would provide additional insights in the hypertensive patients with focal renal artery FMD. A new classification of focal renal artery FMD into IMT or NR subtype based on IVUS was described. Renal FMD Patients with IMT subtype were more likely to achieve cure of hypertension.
迄今为止，很少有研究明确界定血管内超声（IVUS）在肾动脉纤维肌性发育不良（FMD）的诊断和治疗中的作用或效用。我们研究了在患有局灶性肾动脉 FMD 的高血压患者中使用 IVUS 是否会提供更多的见解。这是一项前瞻性观察研究，纳入了 6 年内（2015-2021 年）瑞金医院收治的所有局灶性肾动脉 FMD 患者。根据 IVUS 成像，局灶性 FMD 患者分为两种亚型：血管内膜-中层增厚（IMT）和整个血管的负性重构（NR）。共纳入 36 例连续局灶性肾动脉 FMD 患者（24±7，13-39 岁）。血管造影单灶型 22 例（61.1%），管状型 14 例（38.9%）。22 例单灶患者中，IVUS 显示 18 例（81.8%）为 IMT，4 例（18.2%）为 NR。14 例管状患者中，IVUS 显示 3 例（21.4%）为 IMT，11 例（78.6%）为 NR。在 IMT 和 NR 亚型之间，年龄、性别、BMI、初始血压水平无差异。然而，IMT 患者的短期（血管成形术后 48 小时）（76.2%比 26.7%，p=0.004）和长期（1-6 年）（90.5%比 20.0%，p<0.001）高血压治愈率更高。在本研究中，我们根据 IVUS 将局灶性肾动脉 FMD 分为 IMT 或 NR 亚型。IMT 亚型的肾 FMD 患者更有可能治愈高血压。我们研究了在患有局灶性肾动脉 FMD 的高血压患者中使用 IVUS 是否会提供更多的见解。根据 IVUS 描述了一种新的局灶性肾动脉 FMD 分类，分为 IMT 或 NR 亚型。IMT 亚型的肾 FMD 患者更有可能治愈高血压。
