Abstract 6195: Outcomes of Stenting for Renovascular Disease: A Meta-Regression of the Published Experience
The role of renal artery stenting remains controversial. The majority of data comes from single center experiences. Randomized controlled trials remain incomplete and may lack generalizability to routine practice. To perform a comprehensive systematic review and pooled-analysis of the existing English literature of percutaneous renal artery stenting. Pubmed was searched in January 2008 and all references. All studies published in the English literature were included if they evaluated renal artery stenting and enrolled 15 or more consecutive patients. 46 studies were retrieved that included a total of 5,025 patients with a mean follow-up of 25.2 months after renal artery stenting. The average age was 69.9, and 52.5% were men. 90.4% had severe hypertension, 29.7% had diabetes, 30.5% had chronic kidney disease, and 37.3% of the entire renal mass was at risk prior to stenting (bilateral disease or solitary remaining kidney). Stenting was technically successful in 97.9% of patients with a procedural and all cause mortality of 0.5% and 0.9% respectively. Major complications occurred in 7.9%, and restenosis was detected in 18.5% at 2 years. Following renal artery stenting, pooled and weighted mean average SBP and DBP decreased 11.8% (167.7 to 147.9 mm Hg) and 4.9% (82.9 to 78.8 mm Hg) respectively. Average number of anti-hypertensive agents decreased 14.6% from 2.6 to 2.2 medications. Renal artery stenting resulted in a pooled and weighted mean average reduction in serum creatnine of 10.8% from 1.7 to 1.5 mg/dl. Renal artery stenting is safe and effective. The published observational data suggests it tends to improve blood pressure control, reduces required anti-hypertensive medications, and modestly improves renal function at slightly over 2 year follow-up. These findings are remarkably consistent with the cohort of patients (n=220) reaching the 2 year follow-up milestone in the ASTRAL randomized control trial (Kalra ACC 2008).