Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease: A Prospective 2-Center Cohort Study

Mark Reinhard*, Karoline Schousboe, Ulrik B. Andersen, Niels Henrik Buus, Jesper Moesgaard Rantanen, Jesper Nørgaard Bech, Hossein Mohit Mafi, Sten Langfeldt, Arindam Bharadwaz, Arne Hørlyck, Mogens Kærsgaard Jensen, Jørgen Jeppesen, Michael Hecht Olsen, Ib Abildgaard Jacobsen, Bo Martin Bibby, Kent Lodberg Christensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

13 Citations (Scopus)
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Abstract

BACKGROUND: The aim of this study was to prospectively evaluate the effects of renal artery stenting in consecutive patients with severe atherosclerotic renal artery stenosis and high-risk clinical presentations as defined in a national protocol developed in 2015. METHODS AND RESULTS: Since the protocol was initiated, 102 patients have been referred for revascularization according to the following high-risk criteria: severe renal artery stenosis (≥70%) with true resistant hypertension, rapidly declining kidney function, or recurrent heart failure/sudden pulmonary edema. At baseline, the mean 24-hour ambulatory systolic blood pressure was 166.2 mm Hg (95% CI, 162.0–170.4), the defined daily dose of antihypertensive medication was 6.5 (95% CI, 5.8–7.3), and the estimated glomerular filtration rate was 41.1 mL/min per 1.73m 2 (95% CI, 36.6–45.6). In 96 patients with available 3-month follow-up data, mean 24-hour ambulatory systolic blood pressure decreased by 19.6 mm Hg (95% CI, 15.4–23.8; P<0.001), the defined daily dose of antihypertensive medication was reduced by 52% (95% CI, 41%–62%; P<0.001), and estimated glomerular filtration rate increased by 7.8 mL/ min per 1.73m 2 (95% CI, 4.5–11.1; P<0.001). All changes persisted after 24 month follow-up. Among 17 patients with a history of hospitalization for acute decompensated heart failure, 14 patients had no new episodes after successful revascularization. CONCLUSIONS: In this prospective cohort study, we observed a reduction in blood pressure and antihypertensive medication, an increase in estimated glomerular filtration rate, and a decrease in new hospital admissions attributable to heart failure/sudden pulmonary edema after renal artery stenting.

Original languageEnglish
Article numbere024421
JournalJournal of the American Heart Association
Volume11
Issue number7
Pages (from-to)e024421
ISSN2047-9980
DOIs
Publication statusPublished - 5 Apr 2022

Keywords

  • atherosclerotic renal artery stenosis
  • atherosclerotic renovascular disease
  • flash pulmonary edema
  • rapid loss of kidney function
  • renal revascularization
  • resistant hypertension

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