Balloon Angioplasty and Stent Placement for Atherosclerotic Renal Artery Stenosis: a Retrospective Efficacy Study

JCW Tsang, SCW Cheung, WK Tso, PS Yip, FL Chan

Hong Kong J Radiol 2004;7:31-4

Objective: To assess the effectiveness of angioplasty and/or stenting of atherosclerotic renal artery stenosis on renovascular hypertension and renal function.

Patients and Methods: Between March 2000 and June 2002, seventeen consecutive patients with atherosclerotic renal artery stenosis were referred for renal arteriograms and subsequently underwent balloon angioplasty and/or stenting. Twenty one renal arteries were treated. Eleven patients (64.7%) had both renovascular hypertension and deranged renal function. Four patients (23.5%) were referred for poor hypertension control alone, and 2 patients had impaired renal function alone. Balloon angioplasty was performed first in every case. If repeat angioplasty was unsuccessful, i.e. significant (>60%) residual stenosis and/or the transtenotic pressure gradient was >10 mm Hg, stent placement would be done at the same time. Blood pressure, renal function, and antihypertensive medications were documented during regular follow up before and after the procedure.

Results: Four renal arteries (in 4 patients) were adequately treated with angioplasty without stenting. Seventeen renal arteries (in 13 patients) were treated by angioplasty plus stenting. Blood pressure taken 1 month before and 3 to 6 months after the procedure were compared. Nine patients with hypertension (60%) showed improvement in blood pressure. The other 6 patients (40%) showed no significant change. Of the 13 patients with impaired renal function, 2 (15.3%) showed improvement in renal function, 10 (76.9%) showed no change in renal function, while 1 (13%) had worsening.

Conclusions: Endovascular intervention is highly effective and safe for controlling hypertension due to renal artery stenosis secondary to atherosclerosis