Long-Term Effects of Arterial Stenting on Kidney Function for Patients with Ostial Atherosclerotic Renal Artery Stenosis and Renal Insufficiency

It is uncertain whether renal artery stent placement in patients with atherosclerotic renovascular renal failure can prevent further deterioration of renal function. Therefore, the effects of renal artery stent placement, followed by patency surveillance, were prospectively studied in 63 patients with ostial atherosclerotic renal artery stenosis and renal dysfunc- tion (i.e., serum creatinine concentrations of .120 mmol/L (median serum creatinine concentration, 171 mmol/L; serum creatinine concentration range, 121 to 650 mmol/L). Pre-stent renal (dys) function was stable for 28 patients and declining for 35 patients (defined as a serum creatinine concentration in- crease of $20% in 12 mo). The median follow-up period was 23 mo (interquartile range, 13 to 29 mo). Angioplasty to treat restenosis was performed in 12 cases. Five patients reached end-stage renal failure within 6 mo, and this was related to stent placement in two cases. Two other patients died or were lost to follow-up monitoring within 6 mo, with stable renal function. For the remaining 56 patients, the treatment had no effect on serum creatinine levels if function had previously been stable; if function had been declining, median serum creatinine concentrations improved in the first 1 yr (from 182 mmol/L (135 to 270 mmol/L) to 154 mmol/L (127 to 225 mmol/L); P , 0.05) and remained stable during further fol- low-up monitoring. In conclusion, stent placement, followed by patency surveillance, to treat ostial atherosclerotic renal artery stenosis can stabilize declining renal function. For pa- tients with stable renal dysfunction, the usefulness is less clear. The possible advantages must be weighed against the risk of renal failure advancement with stent placement.