Abstract 1789: Treatment of Renal Artery In-Stent Restenosis: Stent vs PTA
Background: Percutaneous transluminal renal angioplasty with stent (PTRAS) placement has become the treatment of choice for renal artery revascularization. However, one of the major limitations of this procedure is a 15 to 20% rate of in-stent restenosis (ISR). The optimal treatment of renal ISR is not known.
Hypothesis: We tested the hypothesis that the treatment of renal ISR with repeat stenting compared to balloon angioplasty (PTA) alone results in a lower restenosis rate.
Methods: The medical records of 34 consecutive patients (52.9% male), mean age (69.4 ± 8.1) who were treated for renal ISR were reviewed. A total of 18 arteries (17 patients) were treated with PTA and 23 arteries (20 patients) with PTRAS. Follow-up clinical information was available in all patients and follow up angiograms were available for 31 arteries. Follow-up angiography was clinically driven based upon suspicion of restenosis. ISR was defined as 1) ≥ 70% diameter stenosis (DS), 2) ≥ 50% DS if associated with cardiac or renal destabilization, or 3) ≥ 50% DS associated with a translesional gradient ≥ 20 mmHg. Our study endpoints included overall target vessel revascularization (TVR) per vessel, and for those with follow-up angiography, the rate of ISR and stenosis severity were determined. Statistical analysis was performed using the chi-square and unpaired t-test.
Results: The graph shows the endpoints with percent relative reduction (RR) between PTA and PTRAS.
Conclusion: Treating renal ISR with PTRAS is associated with a significantly lower rate of angiographic ISR and a lower percent diameter stenosis with a trend toward reduced TVR compared to PTA alone.