Renal Artery Stent Placement: Utility in Lesions Difficult to Treat With Balloon Angioplasty

Objectives. We assessed the safety and efficacy of stent placement in patients with poorly controlled hypertension and renal artery stenoses, which are difficult to treat with balloon angioplasty alone. Background. Preliminary experience with stent placement suggests improved results over balloon angioplasty alone in patients with atherosclerotic renal artery stenosis. Methods. Balloon-expandable stents were placed in 100 consecutive patients (133 renal arteries) with hypertension and renal artery stenosis. Sixty-seven of the patients had unilateral renal artery stenosis treated and 33 had bilateral renal artery stenoses treated with stents placed in both renal arteries. Results. Angiographic success, as determined by quantitative angiography, was obtained in 132 (99%) of 133 lesions. Early clinical success was achieved in 76% of the patients. Six months after stent placement, the systolic blood pressure was reduced from 173 ± 25 to 147 ± 23 mm Hg (p < 0.001); the diastolic pressure from 88 ± 17 to 76 ± 12 mm Hg (p < 0.001); and the mean number of antihypertensive medications per patient from 2.6 ± 1 to 2.0 ± 0.9 (p < 0.001). Angiographic follow-up at mean of 8.7 ± 5.0 months in 67 patients revealed restenosis (>50% diameter narrowing) in 15 (19%) of 80 stented vessels. Conclusions. Renal artery stenting is an effective treatment for renovascular hypertension, with low angiographic restenosis rate. Stent placement appears to be very attractive therapy in patients with lesions difficult to treat with balloon angioplasty such as renal aorto-ostial lesions and restenotic lesions, as well as after suboptimal balloon angioplasty result.