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(Circulation. 2003;108:2244.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Predictors of Improved Renal Function After Percutaneous Stent-Supported Angioplasty of Severe Atherosclerotic Ostial Renal Artery Stenosis

Thomas Zeller, MD; Ulrich Frank, MD; Christian Müller, MD; Karlheinz Bürgelin, MD; Lutz Sinn, MD; Hans-Peter Bestehorn, MD; Nancy Cook-Bruns, MD; Franz-Josef Neumann, MD

From the Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.

Correspondence to Dr Thomas Zeller, Herz-Zentrum Bad Krozingen, Südring 15, D-79189 Bad Krozingen, Germany. E-mail thomas.zeller{at}herzzentrum.de

Received August 22, 2002; de novo received July 16, 2003; revision received August 12, 2003; accepted August 13, 2003.

Background— Percutaneous stent-supported angioplasty is a treatment option for atherosclerotic ostial renal artery stenosis. Improvement of renal function by such intervention, however, is controversial and thought to be limited to specific subsets, such as nondiabetic patients and bilateral stenoses. In this prospective study, we investigated predictors for improvement of renal function and blood pressure after renal artery stent placement.

Methods and Results— The study included 215 consecutive patients with ostial renal artery stenosis of 70% diameter stenosis undergoing stent-supported angioplasty. The primary end point was decrease in serum creatinine concentration at 1 year; the secondary end point, decrease in average mean arterial blood pressure assessed by 24-hour monitoring. One-year follow-up was complete in 191 surviving patients. In 52% (99/191) of the patients, serum creatinine concentration decreased during 1-year follow-up. Median serum creatinine concentration dropped significantly from 1.21 mg/dL (quartiles: 0.92, 1.60 mg/dL) at baseline to 1.10 mg/dL (quartiles: 0.88, 1.50 mg/dL) at 1 year (P=0.047). On average, mean arterial blood pressure decreased significantly, from 102±12 mm Hg (mean±SD) at baseline to 92±10 mm Hg at 1 year (P<0.001). Significant independent predictors of improved renal function were baseline serum creatinine (odds ratio [95% CI], 2.58 [1.35 to 4.94], P=0.004) and left ventricular function (OR 1.51 [1.04 to 2.21], P=0.032). Female sex, high baseline mean blood pressure, and normal renal parenchymal thickness were independent predictors for decreased mean blood pressure.

Conclusions— Stent-supported angioplasty for severe ostial renal artery stenosis improves renal function and blood pressure in a broader spectrum of patients than previously thought.

Key Words: kidney • stenosis • stents • angioplasty • hypertension

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