Renal artery stenting in patients with chronic ischemic heart disease

Renovascular heart failure: heart failure in patients with atherosclerotic renal artery disease

Atherosclerotic renal artery disease presents with a broad spectrum of clinical features, including heart failure as well as hypertension, and renal failure. Although recent randomized controlled trials failed to demonstrate renal artery stenting can reduce blood pressure or the number of cardiovascular or renal events more so than medical therapy, increasing attention has been paid to flash pulmonary edema and congestive heart failure associated with atherosclerotic renal artery disease. This clinical entity "renovascular heart failure" is diagnosed retrospectively. Given the increasing global burden of heart failure, this review highlights the background and catheter-based therapeutic aspects for renovascular heart failure.

Clinical outcomes and effectiveness of renal artery stenting in patients with critical atherosclerotic renal artery stenosis: does it improve blood pressure control and renal function assessed by estimated glomerular filtration rate?

Introduction

Atherosclerotic renal artery stenosis (ARAS) is associated with uncontrolled hypertension and chronic renal failure.

Aim

To evaluate the influence of gender and presence of chronic renal failure on the outcomes of percutaneous transluminal renal artery stenting (PTRAS) due to atherosclerosis.

Material and methods

A total of 28 ARAS patients underwent PTRAS and 36 stents were placed. Basal characteristics, laboratory data and blood pressure of patients were recorded. The differences between genders and improvement/deterioration of renal functions and blood pressure were analyzed. The predictors of outcomes were determined.

Results

Baseline characteristics were similar between men and women. Significant improvement of systolic and diastolic blood pressure control was achieved after PTRAS (153.04 ±17.07 mm Hg vs. 124.75 ±11.40 mm Hg, p = 0.001 and 92.50 ±10.76 mm Hg vs. 77.54 ±8.23 mm Hg, p < 0.001, respectively). Although mean estimated glomerular filtration rate (eGFR) and creatinine levels did not significantly improve at the 6-month follow-up visit compared to baseline values, of the 28 patients 13 (46.4%) patients had improvement of renal functions.

Conclusions

Our results suggest that PTRAS is a safe procedure and may offer blood pressure control but beneficial effects of PTRAS on renal function may be anticipated in a selected group of patients, especially those with a low eGFR.

Renal intervention to treat hypertension

Renal artery intervention to treat hypertension is one of the frontiers of ongoing research in combating this epidemic. This article focuses on recent data regarding PTRS and catheter-based renal sympathetic denervation. Despite progress in this field large multicenter, randomized trials that compare these treatment modalities with medical therapy for hypertension are lacking.