Abstract 13892: Incidence and Risk Factors of Restenosis, and Its Impact on Blood Pressure Control After Percutaneous Transluminal Renal Angioplasty in Patients With Renovascular Hypertension
Background: Percutaneous transluminal renal angioplasty (PTRA) is one of the standard treatments for renal artery stenosis (RAS). Restenosis after PTRA may influence disease prognosis, but little is known about its frequency, risk factors, or impact on blood pressure control.
Methods: This study included 175 renovascular hypertensive patients (mean age= 59.6 years; 33.7% women; 30.3% fibromuscular dysplasia [FMD]) with 207 treated renal arteries and were followed more than 12 months after PTRA. Data including blood pressure (BP), antihypertensive medication, and duplex ultrasonography (DUS) was collected before and 12 months, and then yearly after PTRA. Cure of hypertension was defines as a BP below 140/90mmHg without antihypertensive medication. Diagnosis of restenosis was based on DUS, by applying a renal aortic ratio >3.5 in conjunction with a renal artery peak systolic velocity > 250cm/s.
Results: At 12 months after PTRA, the cumulative incidence of restenosis was 35 (20.0%). We divided the total patients into four groups on the basis of cause of RAS; FMD or atherosclerotic RAS (ARAS), and the absence/presence of restenosis, and found that the decrease in systolic BP (F=3.10, p<0.05) as well as cure of hypertension (F=6.96, p<0.01) were significantly different among the subgroups. Decrease in systolic BP (-31±19 vs -12±25mmHg, p<0.05) as well as cure of hypertension (36.4 vs 5.0%, p<0.01) were significantly greater in FMD patients without restenosis than those with restenosis; whereas no significant difference was found in patients with ARAS. During a median follow-up of 4.0 (IQR, 1.2-8.0) years, 56 patients (32.0%) developed restenosis. In multivariate Cox regression analysis, FMD was an independent predictor of restenosis (hazard ratio [HR] 2.65, p=0.02). We then divided total patients into two groups according to the cause of RAS, and found that statin use (HR 0.50) in FMD, and the presence of previous cardiovascular disease (HR 2.88) as well as severe RAS (≥90%) (HR 3.30) in ARAS were significant predictors of restenosis (p<0.05, respectively).
Conclusions: Incidence of restenosis after PTRA was higher in FMD than in ARAS among renovascular hypertensive patients. Assessment of restenosis is important for treatment success, especially for FMD.
Author Disclosures: Y. Iwashima: None. T. Fukuda: None. F. Yoshihara: None. H. Kusunoki: None. M. Kishida: None. S. Hayashi: None. S. Nakamura: None. K. Kamide: None. T. Horio: None. Y. Kawano: None.
- © 2015 by American Heart Association, Inc.