Postma C T, Beek F J, van de Ven P J, Joosten F B, Thien T, Beutler J J
Afd. Algemene Interne Geneeskunde, Academisch Ziekenhuis St. Radboud, Nijmegen.
Ned Tijdschr Geneeskd. 1998 Sep 26;142(39):2132-7.
In some patients with hypertension or renal insufficiency, renal artery stenosis can play a causative part. If fibromuscular dysplasia is the pathology of the stenosis, treatment of the stenosis by transluminal percutaneous renal angioplasty (TPRA) results in improvement of the concomitant hypertension in 80-90% of the patients. In case of atherosclerotic lesions 50% of the patients benefit by such treatment. In renal insufficiency TPRA of atherosclerotic lesions results in improvement of renal function in only one third of the patients. As restenosis and elastic recoil are seen as the prime determinants of this lack of success in atherosclerosis, intravascular stents were developed with the aim to accomplish a permanent dilation of the arterial lumen. In recent studies stent placement resulted in cure of high blood pressure in 0-16% of the patients and in improvement in 35-70%. The percentage of improvement must be viewed with caution because of the open design of these studies. Improvement of renal function was reported in 7-36% of the patients and worsening in 8-18%. Based on these outcomes stent placement in stenosed renal arteries should not be regarded as a routine clinical treatment.
在一些高血压或肾功能不全患者中，肾动脉狭窄可能起致病作用。如果纤维肌性发育异常是狭窄的病理表现，经皮腔内肾血管成形术（TPRA）治疗该狭窄可使80%至90%的患者伴发的高血压得到改善。对于动脉粥样硬化病变，50%的患者可从这种治疗中获益。在肾功能不全患者中，动脉粥样硬化病变的TPRA仅使三分之一的患者肾功能得到改善。由于再狭窄和弹性回缩被视为动脉粥样硬化治疗失败的主要决定因素，因此开发了血管内支架，旨在实现动脉管腔的永久性扩张。在最近的研究中，支架置入使0%至16%的患者高血压得到治愈，35%至70%的患者病情得到改善。由于这些研究设计开放，改善的百分比必须谨慎看待。7%至36%的患者肾功能得到改善，8%至18%的患者肾功能恶化。基于这些结果，狭窄肾动脉的支架置入不应被视为常规临床治疗。
