From the William Dorros-Isadore Feuer Interventional Cardiovascular
Disease, Foundation Ltd, Milwaukee, Wis (G.D., L.M., I.I.D., T.H.); the
Arizona Heart Institute Foundation, Phoenix, Ariz (G.D.); and the Vascular
Medicine and Vascular Laboratory, Integrated Cardiovascular Therapeutics, LLC,
Woodbury, NY (M.J.).
Background—Stent
revascularization is perceived as superior to
balloon angioplasty and surgical revascularization,
but the paucity of stent publications precludes even historical
comparison with surgical data.
Methods and Results—Palmaz-Schatz stent
revascularization of renal artery stenosis
was successfully performed on 163 consecutive patients for poorly
controlled hypertension or preservation of renal function. Of these,
145 were eligible for
Conclusions—Renal artery stent
revascularization in the presence of normal or
mildly impaired renal function had a beneficial effect on blood
pressure control and a nondeleterious effect on renal function.
Survival was adversely affected by renal dysfunction despite adequate
revascularization. Early diagnosis and adequate
revascularization before the onset of renal
dysfunction could beneficially affect blood pressure control, preserve
or prevent deterioration of renal function, and improve patient
survival.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Four-Year Follow-up of Palmaz-Schatz Stent Revascularization as Treatment for Atherosclerotic Renal Artery Stenosis
6-month clinical follow-up of the effect of the
procedure on renal function, blood pressure control, number of
antihypertensive medications, and survival. At 4 years,
systolic and diastolic blood pressures
significantly decreased (from 166±26 to 148±22 mm Hg and from
86±14 to 80±11 mm Hg, respectively; P<0.05),
and blood pressure control was more facile in approximately half of the
patients. Creatinine decreased or remained stable in
approximately two thirds of the patients. The cumulative probability of
survival was 74±4% at 3 years, with few deaths related to end-stage
renal disease. Survival was good in patients with normal (92±4%)
baseline renal function, fair (74±7%) in those with mildly impaired
renal function, and poor (52±7%) in patients with elevated baseline
creatinine levels (2.0 mg/dL). The combination of
impaired renal function and bilateral disease adversely affected
survival.
Key Words: stents • stenosis • follow-up studies • revascularization
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
 |
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|