Fiala L A, Jackson M R, Gillespie D L, O'Donnell S D, Lukens M, Gorman P
Vascular Surgery Service, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Ann Vasc Surg. 1998 Mar;12(2):128-33. doi: 10.1007/s100169900128.
Percutaneous transluminal angioplasty for atherosclerotic ostial lesions of the renal arteries has resulted in high restenosis rates. Recent reports of angioplasty with intravascular stenting show improved results over angioplasty alone. The purpose of this study is to review the results of primary stenting of ostial renal artery stenosis at our institution. Twenty one patients (11 men, 10 women, age 63 +/- 11 years), with atherosclerotic renal artery ostial stenosis in association with hypertension or renal insufficiency underwent renal angioplasty with primary stenting during a 2-year period. Medical records were reviewed for indications, technical success, complications, restenosis, response of hypertension and response of renal insufficiency. A technical success was defined as a normal postprocedure arteriogram with no residual stenosis and no residual gradient. Restenosis was defined as > or =60% diameter reduction identified by arteriography, or duplex scan demonstrating a renal artery to aortic ratio of > or =3.5. Thirty-three stents were placed in 25 arteries with four patients having bilateral procedures. All patients were hypertensive. Nine patients (43%) had chronic renal insufficiency (creatinine > or =1.5 mg/dl). One patient was on hemodialysis. The immediate technical success rate was 95%. Six complications occurred in four patients (two pseudoaneurysms, two dissections requiring additional stents, renal failure, and atheroembolization). Mean arterial blood pressure improved from 117 +/- 13.4 to 103 +/- 12.8 mmHg (p = 0.002) after stenting. Serum creatinine levels decreased from 1.48 +/- 0.57 to 1.31 +/- 0.41 (p = 0.07). Eight patients developed restenosis. The mean follow up was 13 +/- 7 months. Life table analysis showed a cumulative restenosis rate of 65 +/- 18% at 24 months. We advise caution in the application of renal stenting for the treatment of ostial lesions, particularly in patients for whom standard surgical revascularization options are available.
经皮腔内血管成形术治疗肾动脉粥样硬化性开口病变导致了较高的再狭窄率。近期有关血管成形术联合血管内支架置入术的报道显示，其效果优于单纯血管成形术。本研究的目的是回顾我们机构对肾动脉开口狭窄进行初次支架置入的结果。21例患者（11例男性，10例女性，年龄63±11岁），患有与高血压或肾功能不全相关的动脉粥样硬化性肾动脉开口狭窄，在2年期间接受了肾血管成形术并初次置入支架。对病历进行了回顾，以了解适应证、技术成功率、并发症、再狭窄情况、高血压的反应以及肾功能不全的反应。技术成功定义为术后动脉造影正常，无残余狭窄且无残余压力阶差。再狭窄定义为动脉造影显示直径减少≥60%，或双功超声扫描显示肾动脉与主动脉比值≥3.5。在25条动脉中置入了33枚支架，4例患者进行了双侧手术。所有患者均患有高血压。9例患者（43%）患有慢性肾功能不全（肌酐≥1.5mg/dl）。1例患者接受血液透析。即刻技术成功率为95%。4例患者出现6种并发症（2例假性动脉瘤、2例夹层需要额外置入支架、肾衰竭和动脉粥样硬化栓塞）。支架置入后平均动脉血压从117±13.4mmHg改善至103±12.8mmHg（p=0.002）。血清肌酐水平从1.48±0.57降至1.31±0.41（p=0.07）。8例患者发生再狭窄。平均随访时间为13±7个月。生命表分析显示24个月时累积再狭窄率为65±18%。我们建议在应用肾支架治疗开口病变时谨慎，尤其是对于有标准外科血管重建选择的患者。
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