Muhammad Nawaz Lashari1, Muhammad Shahzeb Khan2. 1. Department of Cardiology, Civil Hospital, Dow University of Health Sciences, Karachi. 2. Medical Student, Dow University of Health Sciences, Karachi.
Abstract
OBJECTIVE: To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. METHODOLOGY: Hypertension (systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications) with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. RESULTS: There were 25 patients, 14 (56%) male and 11 (44%) female, with mean age of 49 ± 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 (44%), 10 (40%) and 4 (16%) patients respectively. Renal insufficiency (serum creatinine > 1.5 mg/dl) was seen in one (04%) patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 (20%), 9 (36%) and 11(44%) patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 (80%) patients. A significant decrease in systolic (168.20 ± 9.987 vs. 140.60 ± 5.649 mmHg, p < 0.001) and diastolic blood pressure (88.60 ± 5.50 vs. 77.20 ± 5.017 mmHg, p < 0.001) and reduction of medication (2.72 ± 0.458 vs. 1.5 ± 0.510, p < 0.01) were noted without a change in renal function (p= 0.061) after renal artery stenting. CONCLUSION: Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment.
OBJECTIVE: To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. METHODOLOGY:Hypertension (systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications) with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. RESULTS: There were 25 patients, 14 (56%) male and 11 (44%) female, with mean age of 49 ± 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 (44%), 10 (40%) and 4 (16%) patients respectively. Renal insufficiency (serum creatinine > 1.5 mg/dl) was seen in one (04%) patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 (20%), 9 (36%) and 11(44%) patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 (80%) patients. A significant decrease in systolic (168.20 ± 9.987 vs. 140.60 ± 5.649 mmHg, p < 0.001) and diastolic blood pressure (88.60 ± 5.50 vs. 77.20 ± 5.017 mmHg, p < 0.001) and reduction of medication (2.72 ± 0.458 vs. 1.5 ± 0.510, p < 0.01) were noted without a change in renal function (p= 0.061) after renal artery stenting. CONCLUSION: Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment.