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Long-term outcome of stenting for atherosclerotic renal artery stenosis and the effect of angiographic restenosis.

Journal article
Authors Karin Zachrisson
Sven Elverfors
Gert Jensen
Mikael Hellström
Mikael Svensson
Hans Herlitz
Mårten Falkenberg
Published in Acta radiologica
Volume 59
Issue 12
Pages 1438-1445
ISSN 1600-0455
Publication year 2018
Published at Institute of Clinical Sciences, Department of Radiology
Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Pages 1438-1445
Language en
Links dx.doi.org/10.1177/0284185118764209
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Clinical Medicine

Abstract

Background Symptomatic renal artery stenosis (RAS) is mainly treated with pharmacological blood pressure control, sometimes with percutaneous transluminal renal angioplasty (PTRA). It is unclear if PTRA benefits these patients over time. Purpose To determine long-term renal function, morbidity, and mortality in patients with symptomatic RAS treated with PTRA, and whether long-term outcomes are associated with angiographic restenosis. Material and Methods Retrospective single-center, long-term follow-up of 57 patients with atherosclerotic RAS treated with PTRA with stent during 1995-2004 and investigated for restenosis with angiography after one year. Outcomes were retrieved from medical records and from mandatory healthcare registries. Mortality rates were related to expected survival in an age- and gender-matched population, using a life-table database. Surviving patients were assessed with blood pressures, laboratory tests, duplex ultrasonography, and radioisotope renography. Results Median follow-up was 11 years 7 months. Major indications for PTRA were therapy-resistant hypertension and declining renal function. Angiographic restenosis at one year was found in 21 of 57 patients (37%). Thirty-six patients (60%) died during follow-up. Main cause of death was cardiovascular events (54%). Mortality was significantly increased, and morbidity and healthcare utilization were high. Hypertension control during follow-up was stable with persistent need for anti-hypertensive medication, and renal function remained moderately reduced with no long-term difference between patients with vs. without restenosis. Conclusion Long-term prognosis after PTRA for atherosclerotic RAS is dismal, with high mortality and morbidity and reduced renal function, despite maintained hypertension control. Restenosis does not appear to affect late outcome.

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