High technical success rate in patients with renal artery stenosis.

SEATTLE—Outpatient percutaneous renal artery stenting (PRAS) can be safely performed with few major complications, according to a Canadian study presented here at the annual meeting of the Society of Interventional Radiology.

The researchers had a 97.1% technical success rate in a series of 54 patients (30 men, 24 women; median age 62.6 years).

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“The technology has advanced so that the delivery of these stents is becoming slicker, allowing the delivery of these stents with fewer complications. We found our complications rates were very low,” said investigator Eran Hayeems, MD, associate professor medical imaging and assistant professor of medicine at the University of Toronto. “This is one of the largest studies to go back and look at post-procedural complications.”

The 54 patients underwent 59 outpatient PRAS procedures from January 2001 to July 2006. A total of 68 arteries received stents. All the patients had renal artery stenosis and poorly controlled hypertension or renal failure. The stent platform used in the majority of patients was a low profile, over-the-wire 0.0018-inch delivery system. The device is slimmer than stent delivery systems used in the past and thus less prone to causing complications during the procedure.

Despite the high technical success rate, five patients were hospitalized within the first 24 hours after the procedure. Four of the patients had minor complications, including two with a puncture site hematoma and loss of a stent requiring deployment in the iliac artery.

One patient had a renal artery dissection that was successfully treated with a covered stent. The fifth patient had a major complication and suffered renal artery thrombosis, requiring hospitalization. Two delayed complications were observed during 1-to-30 days after the procedure. One patient experienced renal function deterioration and the second patient had renal artery thrombosis (noted above) 12 hours following the procedure and severe GI bleeding three weeks post-procedure.

“This procedure works and it is not associated with high complication rates. We actually found it has low complication rates and low restenosis rates following the procedure,” Dr. Hayeems told Renal & Urology News.

There is a general reluctance on the part of nephrologists to refer patients to interventional radiologists for PRAS because of controversy in the literature whether the procedure is effective in the long-term (10 to 15 years) compared with medical management. Another concern is which patients are most suitable for the treatment.

“Patients who have healthy kidneys and who have not had long-standing problems, such as patients with more acute renal issues, are good candidates for this procedure. It is important that there is a well defined focal lesion that is near to the origin of the renal artery. These types of patients are the ones that will do very well with angioplasty and stenting,” Dr. Hayeems said. Conversely, older patients with long-standing end-stage renal disease will not do as well with this procedure.