Long-term follow-up after renal artery stenting.

BACKGROUND: Renal artery stenosis may cause secondary arterial hypertension and lead to end-stage renal disease. Percutaneous transluminal angioplasty with stent implantation (PTRAS) allows effective and consistent treatment with a high technical success rate. The present trial focuses on the morphological and clinical results as assessed at a long-term follow-up (FU) visit. The main goals were assessment of the restenosis rate and evaluation of arterial hypertension and renal function. PATIENTS AND METHODS: 40 patients who had undergone successful stenting of a main renal artery were prospectively enrolled. At the FU visit, all patients underwent a risk-factor assessment, evaluation of arterial blood pressure and serum creatinine, and multi-detector computed tomography angiography (CTA).
RESULTS: Median FU was 3.3 years. Hyperlipidemia was present in 67.5% of the patients, current cigarette smoking in 35% and diabetes mellitus in 15%. All patients still suffered from arterial hypertension but, compared with the pre-interventional situation, arterial hypertension was improved in 37.5%. Serum creatinine was increased in 25% of patients, mean creatinine level was 1.3 +/- 0.4 mg/dl. Hemodynamically relevant restenosis was detected by observer 1 in five patients and by observer 2 in six patients, giving restenosis rates of 12.5% and 15%, respectively, after the median FU period. Both observers detected three additional relevant stenoses in the contralateral main renal arteries.
CONCLUSIONS: PTRAS gives excellent morphological long-term results. However, the clinical long-term outcome regarding arterial hypertension and renal function is only moderate.