FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 336:459-465 February 13, 1997 Number 7 Next

	Full Text PDF Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Percutaneous transluminal renal angioplasty is a safe and effective treatment for nonostial stenoses of the renal arteries, but it has proved to be disappointing for ostial stenoses. Therefore, we prospectively studied the use of intravascular stents for the treatment of critical ostial stenoses after unsuccessful balloon angioplasty.

Methods Stainless-steel endoprostheses were placed across 74 renal-artery stenoses located within 5 mm of the aortic lumen in 68 patients with hypertension. Twenty patients had mild or severe renal dysfunction. The indications for stent placement were elastic recoil (63 arteries) or dissection (1 artery) of the vessel after angioplasty, or restenosis after initially successful balloon angioplasty (10 arteries). Patients were followed for a mean of 27 months with measurements of blood pressure and serum creatinine, duplex sonography, and intraarterial angiography.

Results Initial technical success was achieved in all patients. Minor complications (local hematomas) occurred in only three patients; there were no major complications. Eighty-four percent of the patients were free of primary occlusion 60 months after the procedure. Restenosis of more than 50 percent of the vessel diameter occurred in 8 of 74 arteries (11 percent). Reintervention resulted in a secondary patency rate of 92 percent. Long-term normalization of blood pressure was achieved in 11 patients (16 percent). Serum creatinine levels did not change significantly after successful stent implantation in patients with previously impaired renal function.

Conclusions Accurate placement of renal-artery stents is technically feasible without major complications. The favorable early and long-term results suggest that primary stent placement is an effective treatment for renal-artery stenosis involving the ostium.

Full Text of this Article

Related Letters:

Treatment of Ostial Renal-Artery Stenoses with Vascular Endoprostheses
Postma C. T., Thien T., Blum U., Krumme B.
Extract | Full Text  
N Engl J Med 1997; 337:132-133, Jul 10, 1997. Correspondence

This article has been cited by other articles:

• Rosenfield, K., Jaff, M. R. (2008). An 82-Year-Old Woman With Worsening Hypertension: Review of Renal Artery Stenosis. JAMA 300: 2036-2044 [Abstract] [Full Text]  
• Uta, H., Michael, K., Hermann, P., Martin, H., Eckhart, B. (2008). A rare case of acute renal failure--acute bilateral renal artery embolism. Nephrol Dial Transplant 23: 2095-2097 [Full Text]  
• Mahmud, E., Smith, T. W.R., Palakodeti, V., Zaidi, O., Ang, L., Mitchell, C. R., Zafar, N., Bromberg-Marin, G., Keramati, S., Tsimikas, S. (2008). Renal Frame Count and Renal Blush Grade: Quantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis. J Am Coll Cardiol Intv 1: 286-292 [Abstract] [Full Text]  
• Dubel, G. J, Murphy, T. P (2008). The role of percutaneous revascularization for renal artery stenosis. Vasc Med 13: 141-156 [Abstract]  
• Bates, M. C., Campbell, J. E., Broce, M., Lavigne, P. S., Riley, M. A. (2008). Serum Creatinine Stabilization Following Renal Artery Stenting. VASC ENDOVASCULAR SURG 42: 40-46 [Abstract]  
• Mahmud, E., Cavendish, J. J., Salami, A. (2007). Current Treatment of Peripheral Arterial Disease: Role of Percutaneous Interventional Therapies. J Am Coll Cardiol 50: 473-490 [Abstract] [Full Text]  
• Talenfeld, A. D., Schwope, R. B., Alper, H. J., Cohen, E. I., Lookstein, R. A. (2007). MDCT Angiography of the Renal Arteries in Patients with Atherosclerotic Renal Artery Stenosis: Implications for Renal Artery Stenting with Distal Protection. Am. J. Roentgenol. 188: 1652-1658 [Abstract] [Full Text]  
• Cooper, C. J., Murphy, T. P. (2007). The Case for Renal Artery Stenting for Treatment of Renal Artery Stenosis. Circulation 115: 263-270 [Full Text]  
• Balk, E., Raman, G., Chung, M., Ip, S., Tatsioni, A., Alonso, A., Chew, P., Gilbert, S. J., Lau, J. (2006). Effectiveness of Management Strategies for Renal Artery Stenosis: A Systematic Review. ANN INTERN MED 145: 901-912 [Abstract] [Full Text]  
• White, C. J. (2006). Catheter-Based Therapy for Atherosclerotic Renal Artery Stenosis. Circulation 113: 1464-1473 [Full Text]  
• Omary, R. A., Gehl, J. A., Schirf, B. E., Green, J. D., Lu, B., Pereles, F. S., Huang, J., Larson, A. C., Li, D. (2006). MR Imaging- versus Conventional X-ray Fluoroscopy-guided Renal Angioplasty in Swine: Prospective Randomized Comparison. Radiology 238: 489-496 [Abstract] [Full Text]  
• Modrall, J. G. (2005). Elevated Brain Natriuretic Peptide Predicts Blood Pressure Response After Stent Revascularization in Patients with Renal Artery Stenosis. PERSPECT VASC SURG ENDOVASC THER 17: 375-376 [Abstract]  
• Rocha-Singh, K., Jaff, M. R., Rosenfield, K., for the ASPIRE-2 Trial Investigators, (2005). Evaluation of the Safety and Effectiveness of Renal Artery Stenting After Unsuccessful Balloon Angioplasty: The ASPIRE-2 Study. J Am Coll Cardiol 46: 776-783 [Abstract] [Full Text]  
• Mahmud, E. (2005). Renal Artery Stenting: Is it Ready for Primetime?. J Am Coll Cardiol 46: 784-786 [Full Text]  
• de Silva, R., Nikitin, N. P., Bhandari, S., Nicholson, A., Clark, A. L., Cleland, J. G.F. (2005). Atherosclerotic renovascular disease in chronic heart failure: should we intervene?. Eur Heart J 26: 1596-1605 [Abstract] [Full Text]  
• Schoenberg, S. O., Rieger, J., Weber, C. H., Michaely, H. J., Waggershauser, T., Ittrich, C., Dietrich, O., Reiser, M. F. (2005). High-Spatial-Resolution MR Angiography of Renal Arteries with Integrated Parallel Acquisitions: Comparison with Digital Subtraction Angiography and US. Radiology 235: 687-698 [Abstract] [Full Text]  
• Kwolek, C. J. (2004). Endovascular Management of Renal Artery Stenosis: Current Techniques and Results. PERSPECT VASC SURG ENDOVASC THER 16: 261-276 [Abstract]  
• Hansen, K. J., Wilson, D. B., Edwards, M. S. (2004). Surgical Revascularization of Atherosclerotic Renovascular Disease: State of the Art. PERSPECT VASC SURG ENDOVASC THER 16: 281-295 [Abstract]  
• Li, J.-J., Fang, C.-H., Jiang, H., Hunag, C.-X., Tang, Q.-Z., Wang, X.-H., Li, G.-S. (2004). Increased C-Reactive Protein Level After Renal Stent Implantation in Patients with Atherosclerotic Renal Stenosis. ANGIOLOGY 55: 479-484 [Abstract]  
• Murphy, T. P., Soares, G., Kim, M. (2004). Increase in Utilization of Percutaneous Renal Artery Interventions by Medicare Beneficiaries, 1996-2000. Am. J. Roentgenol. 183: 561-568 [Abstract] [Full Text]  
• Morvay, Z., Nagy, E., Bagi, R., Abraham, G., Sipka, R., Palko, A. (2004). Sonographic Follow-up After Visceral Artery Stenting. J Ultrasound Med 23: 1057-1064 [Abstract] [Full Text]  
• Bittl, J. A., Hirsch, A. T. (2004). Concomitant Peripheral Arterial Disease and Coronary Artery Disease: Therapeutic Opportunities. Circulation 109: 3136-3144 [Full Text]  
• Han, B. G., Kim, J. Y., Choi, J. U., Lee, S. H., Choi, S. O. (2004). An acute renal failure patient successfully stented for bilateral renal artery occlusion with a distal embolism protection device. Nephrol Dial Transplant 19: 1662-1663 [Full Text]  
• Bettmann, M. A., Dake, M. D., Hopkins, L. N., Katzen, B. T., White, C. J., Eisenhauer, A. C., Pearce, W. H., Rosenfield, K. A., Smalling, R. W., Sos, T. A., Venbrux, A. C. (2004). Atherosclerotic Vascular Disease Conference: Writing Group VI: Revascularization. Circulation 109: 2643-2650 [Full Text]  
• Sezer, M., Nisanci, Y., Ozsaruhan, O., Olcay, A., Ecder, T. (2003). Stenting for bilateral renal artery occlusion: a report of two cases. Nephrol Dial Transplant 18: 2663-2664 [Full Text]  
• Zeller, T., Frank, U., Muller, C., Burgelin, K., Sinn, L., Bestehorn, H.-P., Cook-Bruns, N., Neumann, F.-J. (2003). Predictors of Improved Renal Function After Percutaneous Stent-Supported Angioplasty of Severe Atherosclerotic Ostial Renal Artery Stenosis. Circulation 108: 2244-2249 [Abstract] [Full Text]  
• Soulez, G., Therasse, E., Qanadli, S. D., Froment, D., Leveille, M., Nicolet, V., Turpin, S., Giroux, M.-F., Guertin, M. C., Oliva, V. L. (2003). Prediction of Clinical Response After Renal Angioplasty: Respective Value of Renal Doppler Sonography and Scintigraphy. Am. J. Roentgenol. 181: 1029-1035 [Abstract] [Full Text]  
• Turi, Z. G., Jaff, M. R. (2003). Renal artery stenosis: searching for the algorithms for diagnosis and treatment. J Am Coll Cardiol 41: 1312-1315 [Full Text]  
• Gill, K. S., Fowler, R. C. (2003). Atherosclerotic Renal Arterial Stenosis: Clinical Outcomes of Stent Placement for Hypertension and Renal Failure. Radiology 226: 821-826 [Abstract] [Full Text]  
• Wacker, F. K., Reither, K., Ebert, W., Wendt, M., Lewin, J. S., Wolf, K.-J. (2003). MR Image-guided Endovascular Procedures with the Ultrasmall Superparamagnetic Iron Oxide SH U 555 C as an Intravascular Contrast Agent: Study in Pigs. Radiology 226: 459-464 [Abstract] [Full Text]  
• Gray, B. H, Olin, J. W, Childs, M. B., Sullivan, T. M, Bacharach, J M. (2002). Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure. Vasc Med 7: 275-279 [Abstract]  
• Zoccali, C., Mallamaci, F., Finocchiaro, P. (2002). Atherosclerotic Renal Artery Stenosis: Epidemiology, Cardiovascular Outcomes, and Clinical Prediction Rules. J. Am. Soc. Nephrol. 13: S179-183 [Abstract] [Full Text]  
• Rundback, J. H., Sacks, D., Kent, K. C., Cooper, C., Jones, D., Murphy, T., Rosenfield, K., White, C., Bettmann, M., Cortell, S., Puschett, J., Clair, D., Cole, P., for the AHA Councils on Cardiovascular Radiology,, (2002). Guidelines for the Reporting of Renal Artery Revascularization in Clinical Trials. Circulation 106: 1572-1585 [Full Text]  
• Krumme, B., Mann, J. F. E. (2001). Atherosclerotic renal artery stenosis in 2001--are we less confused than before?. Nephrol Dial Transplant 16: 2124-2127 [Full Text]  
• BEUTLER, J. J., VAN AMPTING, J. M. A., VEN, P. J. G. V. D., KOOMANS, H. A., BEEK, F. J. A., WOITTIEZ, A.-J. J., MALI, W. P. T. M. (2001). Long-Term Effects of Arterial Stenting on Kidney Functionfor Patients with Ostial Atherosclerotic Renal Artery Stenosis and Renal Insufficiency. J. Am. Soc. Nephrol. 12: 1475-1481 [Abstract] [Full Text]  
• Sharafuddin, M. J. A., Raboi, C. A., Abu-Yousef, M., Lawton, W. J., Gordon, J. A. (2001). Renal Artery Stenosis: Duplex US after Angioplasty and Stent Placement. Radiology 220: 168-173 [Abstract] [Full Text]  
• Alhaddad, I. A., Blum, S., Heller, E. N., Beato, M. A., Bhalodkar, N. C., Keriaky, G. E., Brown, E. J. Jr (2001). Renal Artery Stenosis in Minority Patients Undergoing Diagnostic Cardiac Catheterization: Prevalence and Risk Factors. J CARDIOVASC PHARMACOL THER 6: 147-153 [Abstract]  
• BATIDE-ALANORE, A. L., AZIZI, M., FROISSART, M., RAYNAUD, A., PLOUIN, P.-F. (2001). Split Renal Function Outcome after Renal Angioplasty in Patients with Unilateral Renal Artery Stenosis. J. Am. Soc. Nephrol. 12: 1235-1241 [Abstract] [Full Text]  
• Spinosa, D. J., Matsumoto, A. H., Angle, J. F., Hagspiel, K. D., Cage, D., Bissonette, E. A., Koenig, K. G., Ayers, C. R., McConnell, K. (2001). Safety of CO2- and Gadodiamide-Enhanced Angiography for the Evaluation and Percutaneous Treatment of Renal Artery Stenosis in Patients with Chronic Renal Insufficiency. Am. J. Roentgenol. 176: 1305-1311 [Abstract] [Full Text]  
• Safian, R. D., Textor, S. C. (2001). Renal-Artery Stenosis. NEJM 344: 431-442 [Full Text]  
• Watson, P. S., Hadjipetrou, P., Cox, S. V., Piemonte, T. C., Eisenhauer, A. C. (2000). Effect of Renal Artery Stenting on Renal Function and Size in Patients with Atherosclerotic Renovascular Disease. Circulation 102: 1671-1677 [Abstract] [Full Text]  
• Tan, W. A., Wholey, M. H., Olin, J. W., Mann, S. J., Pecker, M. S., August, P., van Jaarsveld, B. C., Krijnen, P., Deinum, J. (2000). The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis. NEJM 343: 438-439 [Full Text]  
• Baumgartner, I., von Aesch, K., Do, D.-D., Triller, J., Birrer, M., Mahler, F. (2000). Stent Placement in Ostial and Nonostial Atherosclerotic Renal Arterial Stenoses: A Prospective Follow-up Study. Radiology 216: 498-505 [Abstract] [Full Text]  
• Leertouwer, T. C., Gussenhoven, E. J., Bosch, J. L., van Jaarsveld, B. C., van Dijk, L. C., Deinum, J., Man in 't Veld, A. J. (2000). Stent Placement for Renal Arterial Stenosis: Where Do We Stand? A Meta-analysis. Radiology 216: 78-85 [Abstract] [Full Text]  
• Suresh, M., Laboi, P., Mamtora, H., Kalra, P. A. (2000). Relationship of renal dysfunction to proximal arterial disease severity in atherosclerotic renovascular disease. Nephrol Dial Transplant 15: 631-636 [Abstract] [Full Text]  
• van Jaarsveld, B. C., Krijnen, P., Pieterman, H., Derkx, F. H.M., Deinum, J., Postma, C. T., Dees, A., Woittiez, A. J.J., Bartelink, A. K.M., Man in `t Veld, A. J., Schalekamp, M. A.D.H., The Dutch Renal Artery Stenosis Intervention Coope, (2000). The Effect of Balloon Angioplasty on Hypertension in Atherosclerotic Renal-Artery Stenosis. NEJM 342: 1007-1014 [Abstract] [Full Text]  
• Ritz, E., Mann, J. F.E. (2000). Renal Angioplasty for Lowering Blood Pressure. NEJM 342: 1042-1043 [Full Text]  
• De Cobelli, F., Venturini, M., Vanzulli, A., Sironi, S., Salvioni, M., Angeli, E., Scifo, P., Garancini, M. P., Quartagno, R., Bianchi, G., Maschio, A. D. (2000). Renal Arterial Stenosis: Prospective Comparison of Color Doppler US and Breath-hold, Three-dimensional, Dynamic, Gadolinium-enhanced MR Angiography. Radiology 214: 373-380 [Abstract] [Full Text]  
• Kuroda, S., Nishida, N., Uzu, T., Takeji, M., Nishimura, M., Fujii, T., Nakamura, S., Inenaga, T., Yutani, C., Kimura, G. (2000). Prevalence of Renal Artery Stenosis in Autopsy Patients With Stroke. Stroke 31: 61-65 [Abstract] [Full Text]  
• Morris, P. P., Martin, E. M., Regan, J., Braden, G. (1999). Intracranial Deployment of Coronary Stents for Symptomatic Atherosclerotic Disease. Am. J. Neuroradiol. 20: 1688-1694 [Abstract] [Full Text]  
• Carmichael, P., Carmichael, A. R (1999). Current concepts: Atherosclerotic renal artery stenosis: from diagnosis to treatment. Postgrad. Med. J. 75: 527-536 [Abstract] [Full Text]  
• Xue, F., Bettmann, M. A., Langdon, D. R., Wivell, W. A. (1999). Outcome and Cost Comparison of Percutaneous Transluminal Renal Angioplasty, Renal Arterial Stent Placement, and Renal Arterial Bypass Grafting. Radiology 212: 378-384 [Abstract] [Full Text]  
• Leertouwer, T. C., Gussenhoven, E. J., van Dijk, L. C., van Essen, J. A., Honkoop, J., Deinum, J., Pattynama, P. M. T. (1999). Intravascular Ultrasound Evidence for Coarctation Causing Symptomatic Renal Artery Stenosis. Circulation 99: 2976-2978 [Abstract] [Full Text]  
• Isles, C.G., Robertson, S., Hill, D. (1999). Management of renovascular disease: a review of renal artery stenting in ten studies. QJM 92: 159-167 [Abstract] [Full Text]  
• Caps, M. T., Perissinotto, C., Zierler, R. E., Polissar, N. L., Bergelin, R. O., Tullis, M. J., Cantwell-Gab, K., Davidson, R. C., Strandness, D. E. Jr (1998). Prospective Study of Atherosclerotic Disease Progression in the Renal Artery. Circulation 98: 2866-2872 [Abstract] [Full Text]  
• Svensson, L. G., Cambria, R. P. (1998). Expanding Surgical Options Using Minimally Invasive Techniques for Cardio-aortic and Aortic Procedures. Arch Surg 133: 1160-1165 [Abstract] [Full Text]  
• Carlier, S. G., Li, W., Cespedes, E. I., van der Steen, A. F. W., Hamburger, J. N., Bom, N., Serruys, P. W. (1998). Simultaneous Morphological and Functional Assessment of a Renal Artery Stent Intervention With Intravascular Ultrasound. Circulation 97: 2575-2576 [Full Text]  
• Zierler, R. E., Bergelin, R. O., Polissar, N. L., Beach, K. W., Caps, M. T., Cantwell-Gab, K., Davidson, R. C., Strandness, D. E. Jr (1998). Carotid and Lower Extremity Arterial Disease in Patients With Renal Artery Atherosclerosis. Arch Intern Med 158: 761-767 [Abstract] [Full Text]  
• Plouin, P.-F., Chatellier, G., Darne, B., Raynaud, A. (1998). Blood Pressure Outcome of Angioplasty in Atherosclerotic Renal Artery Stenosis : A Randomized Trial. Hypertension 31: 823-829 [Abstract] [Full Text]  
• Bettmann, M. A., Katzen, B. T., Whisnant, J., Brant-Zawadzki, M., Broderick, J. P., Furlan, A. J., Hershey, L. A., Howard, V., Kuntz, R., Loftus, C. M., Pearce, W., Roberts, A., Roubin, G. (1998). Carotid Stenting and Angioplasty : A Statement for Healthcare Professionals From the Councils on Cardiovascular Radiology, Stroke, Cardio-Thoracic and Vascular Surgery, Epidemiology and Prevention, and Clinical Cardiology, American Heart Association. Circulation 97: 121-123 [Full Text]  
• Bettmann, M. A., Katzen, B. T., Whisnant, J., Brant-Zawadzki, M., Broderick, J. P., Furlan, A. J., Hershey, L. A., Howard, V., Kuntz, R., Loftus, C. M., Pearce, W., Roberts, A., Roubin, G. (1998). Carotid Stenting and Angioplasty : A Statement for Healthcare Professionals From the Councils on Cardiovascular Radiology, Stroke, Cardio-Thoracic and Vascular Surgery, Epidemiology and Prevention, and Clinical Cardiology, American Heart Association. Stroke 29: 336-338 [Full Text]  
• Postma, C. T., Thien, T., Blum, U., Krumme, B. (1997). Treatment of Ostial Renal-Artery Stenoses with Vascular Endoprostheses. NEJM 337: 132-133 [Full Text]  
• Mallouhi, A., Schocke, M., Judmaier, W., Wolf, C., Dessl, A., Czermak, B. V., Waldenberger, P., Jaschke, W. R. (2002). 3D MR Angiography of Renal Arteries: Comparison of Volume Rendering and Maximum Intensity Projection Algorithms. Radiology 223: 509-516 [Abstract] [Full Text]