Meng Peng1, Wei Ji1, Xiongjing Jiang2, Hui Dong1, Yubao Zou1, Lei Song1, Huimin Zhang1, Weiguo Zhang3, Yuejin Yang1, Runlin Gao1. 1. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. 2. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China. Electronic address: jiangxiongjing@163.com. 3. Cardiovascular and Neurologic Institute, Irving, TX 75039, USA.
Abstract
OBJECTIVES: We aimed to investigate the long-term clinical outcomes of selective stenting versus percutaneous balloon angioplasty (PTA) in hypertensive patients with renal artery stenosis caused by Takayasu arteritis (RASTA). METHODS: We retrospectively analyzed the data of consecutive 152 RASTA patients from Fuwai Hospital between 2005 and 2012. All target lesions of renal arteries were firstly treated by plain PTA. After angioplasty, if flow-limited dissection and/or residual stenosis >50% of diameter on angiogram existed, a selective stenting was then followed to further morphological improvement. RESULTS: The baseline characteristics between PTA (n=93) and stenting groups (n=59) were indistinguishable. At two-year follow-up, the rates of normalized, improved, and unaltered hypertension were 27.4%, 63.4% and 12.3% in PTA group (n=93) versus 22.4%, 62.1% and 15.5% respectively in stenting group (p=0.79). Primary patency rate was 90.1% in renal arteries (125 lesions) treated with PTA versus 75.6% in renal arteries (64 lesions) treated with stent placement (p=0.008). Female, active stage of the disease requiring glucocorticoid and/or immunosuppressant agents, residual stenosis rate and stenting were significantly associated with the restenosis. In patients with restenosis, renal artery occlusion occurred more in stenting group (8/15), compared with that in PTA group (1/12) (p=0.019). The stenting group underwent more reintervention procedures than PTA group (13/63 versus 8/125, p=0.003). CONCLUSIONS: If PTA alone failed in treating RASTA, selective stenting resulted in similarly effective blood pressure reduction. Stenting also resulted in lower 2-year primary patency rate, higher occlusion rate and higher reintervention rate than those who did not need stenting.
OBJECTIVES: We aimed to investigate the long-term clinical outcomes of selective stenting versus percutaneous balloon angioplasty (PTA) in hypertensivepatients with renal artery stenosis caused by Takayasu arteritis (RASTA). METHODS: We retrospectively analyzed the data of consecutive 152 RASTApatients from Fuwai Hospital between 2005 and 2012. All target lesions of renal arteries were firstly treated by plain PTA. After angioplasty, if flow-limited dissection and/or residual stenosis >50% of diameter on angiogram existed, a selective stenting was then followed to further morphological improvement. RESULTS: The baseline characteristics between PTA (n=93) and stenting groups (n=59) were indistinguishable. At two-year follow-up, the rates of normalized, improved, and unaltered hypertension were 27.4%, 63.4% and 12.3% in PTA group (n=93) versus 22.4%, 62.1% and 15.5% respectively in stenting group (p=0.79). Primary patency rate was 90.1% in renal arteries (125 lesions) treated with PTA versus 75.6% in renal arteries (64 lesions) treated with stent placement (p=0.008). Female, active stage of the disease requiring glucocorticoid and/or immunosuppressant agents, residual stenosis rate and stenting were significantly associated with the restenosis. In patients with restenosis, renal artery occlusion occurred more in stenting group (8/15), compared with that in PTA group (1/12) (p=0.019). The stenting group underwent more reintervention procedures than PTA group (13/63 versus 8/125, p=0.003). CONCLUSIONS: If PTA alone failed in treating RASTA, selective stenting resulted in similarly effective blood pressure reduction. Stenting also resulted in lower 2-year primary patency rate, higher occlusion rate and higher reintervention rate than those who did not need stenting.
Authors: Ana F Águeda; Sara Monti; Raashid Ahmed Luqmani; Frank Buttgereit; Maria Cid; Bhaskar Dasgupta; Christian Dejaco; Alfred Mahr; Cristina Ponte; Carlo Salvarani; Wolfgang Schmidt; Bernhard Hellmich Journal: RMD Open Date: 2019-09-23