Chapter 79
Renal Artery Interventions
Mark Shipeng Yu,
Kun Xiang, Steven T. Haller,
Christopher J. Cooper,
Mark Shipeng Yu
Search for more papers by this authorSteven T. Haller
Search for more papers by this authorChristopher J. Cooper
Search for more papers by this authorMark Shipeng Yu,
Kun Xiang, Steven T. Haller,
Christopher J. Cooper,
Mark Shipeng Yu
Search for more papers by this authorSteven T. Haller
Search for more papers by this authorChristopher J. Cooper
Search for more papers by this authorBook Editor(s):George D. Dangas MD, MACC, MSCAI, FAHA, FESC,
Carlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC,
Holger Thiele MD,
Peter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP,
Tayo Addo MD, Bimmer Claessen MD, Christian Hengstenberg MD, Nicholas Kipshidze MD,
George D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorFirst published: 06 May 2022
Summary
Renal artery stenosis (RAS) is narrowing of the renal arteries, most often occurring in the main renal artery. Atherosclerotic renal artery stenosis (ARAS) is caused by atherosclerotic plaque in the renal artery wall and is a chronic inflammatory process affected by multiple factors. Duplex ultrasonography, computed tomographic angiography (CT angiography, or CTA), and magnetic resonance angiography (MRA) are recommended by guideline as screening tests to establish the diagnosis of RAS. While balloon angioplasty is the standard interventional treatment for FMD, for ARAS there has been considerable debate over the past several decades about which treatment modality is better when considering medical therapy versus stenting. The direct goal of renal artery intervention is to obtain the optimal patency of the artery while minimizing the risk of atheroembolization, renal artery dissection, and other complications. The chapter describes the techniques for stenting ostial ARAS, as these are the most common.
References
- Cooper CJ , Murphy TP , Cutlip DE , et al . Stenting and medical therapy for atherosclerotic renal-artery stenosis . N Engl J Med 2014 ; 370 ( 1 ): 13 – 22 .
- Caps MT , Perissinotto C , Zierler RE , et al . Prospective study of atherosclerotic disease progression in the renal artery . Circulation 1998 ; 98 ( 25 ): 2866 – 2872 .
- Schreiber MJ , Pohl MA , Novick AC . The natural history of atherosclerotic and fibrous renal artery disease . Urol Clin North Am 1984 ; 11 ( 3 ): 383 – 392 .
- Weber BR , Dieter RS . Renal artery stenosis: epidemiology and treatment . Int J Nephrol Renovasc Dis 2014 ; 7 : 169 – 181 .
- Mailloux LU , Napolitano B , Bellucci AG , et al . Renal vascular disease causing end-stage renal disease, incidence, clinical correlates, and outcomes: a 20-year clinical experience . Am J Kidney Dis 1994 ; 24 ( 4 ): 622 – 629 .
- Haller ST , Evans KL , Folt DA , et al . Mechanisms and treatments for renal artery stenosis . Discov Med 2013 ; 16 ( 90 ): 255 – 260 .
- Textor SC . Ischemic nephropathy: where are we now? J Am Soc Nephrol 2004 ; 15 ( 8 ): 1974 – 1982 .
- Haller ST , Kalra PA , Ritchie JP , et al . Effect of CD40 and sCD40L on renal function and survival in patients with renal artery stenosis . Hypertension 2013 ; 61 ( 4 ): 894 – 900 .
- Gottam N , Nanjundappa A , Dieter RS . Renal artery stenosis: pathophysiology and treatment . Exp Rev Cardiovasc Ther 2009 ; 7 ( 11 ): 1413 – 1420 .
- Conlon PJ , Little MA , Pieper K , Mark DB . Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography . Kidney Int 2001 ; 60 ( 4 ): 1490 – 1497 .
- Mui K-W , Sleeswijk M , van den Hout H , et al . Incidental renal artery stenosis is an independent predictor of mortality in patients with peripheral vascular disease . J Am Soc Nephrol 2006 ; 17 ( 7 ): 2069 – 2074 .
- Johansson M , Herlitz H , Jensen G , et al . Increased cardiovascular mortality in hypertensive patients with renal artery stenosis: relation to sympathetic activation, renal function and treatment regimens . J Hypertens 1999 ; 17 ( 12 Pt 1 ): 1743 – 1750 .
- Kalra PA , Guo H , Kausz AT , et al . Atherosclerotic renovascular disease in United States patients aged 67 years or older: risk factors, revascularization, and prognosis . Kidney Int 2005 ; 68 ( 1 ): 293 – 301 .
- Dorros G , Jaff M , Mathiak L , et al . Four-year follow-up of Palmaz-Schatz stent revascularization as treatment for atherosclerotic renal artery stenosis . Circulation 1998 ; 98 ( 7 ): 642 – 647 .
- Alderson HV , Ritchie JP , Kalra PA . Revascularization as a treatment to improve renal function . Int J Nephrol Renovasc Dis 2014 ; 7 : 89 – 99 .
- Guo H , Kalra PA , Gilbertson DT , et al . Atherosclerotic renovascular disease in older US patients starting dialysis, 1996 to 2001 . Circulation 2007 ; 115 ( 1 ): 50 – 58 .
- Dworkin LD , Cooper CJ . Clinical practice: Renal-artery stenosis . N Engl J Med 2009 ; 361 ( 20 ): 1972 – 1978 .
- Slovut DP , Olin JW . Fibromuscular dysplasia . N Engl J Med 2004 ; 350 ( 18 ): 1862 – 1871 .
- Anderson JL , Halperin JL , Albert NM , et al . Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines . Circulation 2013 ; 127 ( 13 ): 1425 – 1443 .
- Olin JW , Piedmonte MR , Young JR , et al . The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis . Ann Intern Med 1995 ; 122 ( 11 ): 833 – 838 .
- American Institute of Ultrasound in Medicine practice guideline for the performance of native renal artery duplex sonography . J Ultrasound Med 2013 ; 32 ( 7 ): 1331 – 1340 .
- Soares GM , Murphy TP , Singha MS , et al . Renal artery duplex ultrasonography as a screening and surveillance tool to detect renal artery stenosis: a comparison with current reference standard imaging . J Ultrasound Med 2006 ; 25 ( 3 ): 293 – 298 .
- Stavros AT , Parker SH , Yakes WF , et al . Segmental stenosis of the renal artery: pattern recognition of tardus and parvus abnormalities with duplex sonography . Radiology 1992 ; 184 ( 2 ): 487 – 492 .
- Rocha-Singh K , Jaff MR , Lynne Kelley E . Renal artery stenting with noninvasive duplex ultrasound follow-up: 3-year results from the RENAISSANCE renal stent trial . Catheter Cardiovasc Interv 2008 ; 72 ( 6 ): 853 – 862 .
- Mohabbat W , Greenberg RK , Mastracci TM , et al . Revised duplex criteria and outcomes for renal stents and stent grafts following endovascular repair of juxtarenal and thoracoabdominal aneurysms . J Vasc Surg 2009 ; 49 ( 4 ): 827 – 837 ; discussion 837.
- Eklof H , Ahlstrom H , Magnusson A , et al . A prospective comparison of duplex ultrasonography, captopril renography, MRA, and CTA in assessing renal artery stenosis . Acta Radiol 2006 ; 47 ( 8 ): 764 – 774 .
- Rountas C , Vlychou M , Vassiou K , et al . Imaging modalities for renal artery stenosis in suspected renovascular hypertension: prospective intraindividual comparison of color Doppler US, CT angiography, GD-enhanced MR angiography, and digital substraction angiography . Renal Fail 2007 ; 29 ( 3 ): 295 – 302 .
- Colyer WR Jr , Cooper CJ , Burket MW , Thomas WJ . Utility of a 0.014” pressuresensing guidewire to assess renal artery translesional systolic pressure gradients . Catheter Cardiovasc Interv 2003 ; 59 ( 3 ): 372 – 377 .
- Kadziela J , Witkowski A , Januszewicz A , et al . Assessment of renal artery stenosis using both resting pressures ratio and fractional flow reserve: relationship to angiography and ultrasonography . Blood Pressure 2011 ; 20 ( 4 ): 211 – 217 .
- Ito T , Tani T , Fujita H , Ohte N . Relationship between fractional flow reserve and residual plaque volume and clinical outcomes after optimal drug-eluting stent implantation: insight from intravascular ultrasound volumetric analysis . Int J Cardiol 2014 ; 176 ( 2 ): 399 – 404 .
- Wheatley K , Ives N , Gray R , et al . Revascularization versus medical therapy for renal-artery stenosis . N Engl J Med 2009 ; 361 ( 20 ): 1953 – 1962 .
- Bax L , Woittiez AJ , Kouwenberg HJ , et al . Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial . Ann Intern Med 2009 ; 150 ( 12 ): 840 – 848 .
- Watson PS , Hadjipetrou P , Cox SV , et al . Effect of renal artery stenting on renal function and size in patients with atherosclerotic renovascular disease . Circulation 2000 ; 102 ( 14 ): 1671 – 1677 .
- Muray S , Martin M , Amoedo ML , et al . Rapid decline in renal function reflects reversibility and predicts the outcome after angioplasty in renal artery stenosis . Am J Kidney Dis 2002 ; 39 ( 1 ): 60 – 66 .
- Ritchie J , Green D , Chrysochou C , et al . High-risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization . Am J Kidney Dis 2014 ; 63 ( 2 ): 186 – 197 .
- Bloch MJ , Trost DW , Pickering TG , et al . Prevention of recurrent pulmonary edema in patients with bilateral renovascular disease through renal artery stent placement . Am J Hypertens 1999 ; 12 ( 1 Pt 1 ): 1 – 7 .
- Pelta A , Andersen UB , Just S , Baekgaard N . Flash pulmonary edema in patients with renal artery stenosis: the Pickering Syndrome . Blood Pressure 2011 ; 20 ( 1 ): 15 – 19 .
- Cheung CM , Chrysochou C , Shurrab AE , et al . Effects of renal volume and single-kidney glomerular filtration rate on renal functional outcome in atherosclerotic renal artery stenosis . Nephrol Dial Transplant 2010 ; 25 ( 4 ): 1133 – 1140 .
- Chrysochou C , Mendichovszky IA , Buckley DL , et al . BOLD imaging: a potential predictive biomarker of renal functional outcome following revascularization in atheromatous renovascular disease . Nephrol Dial Transplant 2012 ; 27 ( 3 ): 1013 – 1019 .
- Silva JA , Chan AW , White CJ , et al . Elevated brain natriuretic peptide predicts blood pressure response after stent revascularization in patients with renal artery stenosis . Circulation 2005 ; 111 ( 3 ): 328 – 333 .
- Jaff MR , Bates M , Sullivan T , et al . Significant reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: results from the HERCULES trial . Catheter Cardiovasc Interv 2012 ; 80 ( 3 ): 343 – 350 .
- Radermacher J , Chavan A , Bleck J , et al . Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis . N Engl J Med 2001 ; 344 ( 6 ): 410 – 417 .
- Crutchley TA , Pearce JD , Craven TE , et al . Clinical utility of the resistive index in atherosclerotic renovascular disease . J Vasc Surg 2009 ; 49 ( 1 ): 148 – 155 , 55 e1–3; discussion 155.
- Bruno RM , Daghini E , Versari D , et al . Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis: a monocentric observational study . Cardiovasc Ultrasound 2014 ; 12 : 9 .
- Hodsman GP , Brown JJ , Cumming AM , et al . Enalapril (MK421) in the treatment of hypertension with renal artery stenosis . J Hypertens Suppl 1983 ; 1 ( 1 ): 109 – 117 .
- Karlberg BE , Fyhrquist F , Gronhagen-Riska C , et al . Enalapril and lisinopril in renovascular hypertension: antihypertensive and hormonal effects of two new angiotensin-converting-enzyme (ACE) inhibitors. A preliminary report . Scand J Urol Nephrol Suppl 1984 ; 79 : 103 – 106 .
- Chrysochou C , Foley RN , Young JF , et al . Dispelling the myth: the use of renin-angiotensin blockade in atheromatous renovascular disease . Nephrol Dial Transplant 2012 ; 27 ( 4 ): 1403 – 1409 .
- Orth SR , Hallan SI . Smoking: a risk factor for progression of chronic kidney disease and for cardiovascular morbidity and mortality in renal patients— absence of evidence or evidence of absence? Clin J Am Soc Nephrol 2008 ; 3 ( 1 ): 226 – 236 .
- Yu MS , Folt DA , Drummond CA , et al . Endovascular versus medical therapy for atherosclerotic renovascular disease . Curr Atheroscler Rep 2014 ; 16 ( 12 ): 459 .
- Wang LC , Scott DJ , Clemens MS , et al . Mechanism of stent failure in a patient with fibromuscular dysplasia following renal artery stenting . Ann Vasc Surg 2015 ; 29 ( 1 ): e19 – 21 .
- Tanaka A , Takahashi S , Saito S . Migration of fractured renal artery stent . Catheter Cardiovasc Interv 2011 ; 77 ( 2 ): 305 – 307 .
- Park HS , Do YS , Park KB , et al . Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: angioplasty versus stent placement . Eur J Radiol 2013 ; 82 ( 11 ): 1913 – 1918 .
- Perera AH , Youngstein T , Gibbs RG , et al . Optimizing the outcome of vascular intervention for Takayasu arteritis . Br J Surg 2014 ; 101 ( 2 ): 43 – 50 .
- Cooper CJ , Haller ST , Colyer W , et al . Embolic protection and platelet inhibition during renal artery stenting . Circulation 2008 ; 117 ( 21 ): 2752 – 2760 .
- Henry M , Klonaris C , Henry I , et al . Protected renal stenting with the PercuSurge GuardWire device: a pilot study . J Endovasc Ther 2001 ; 8 ( 3 ): 227 – 237 .
- Holden A , Hill A , Jaff MR , Pilmore H . Renal artery stent revascularization with embolic protection in patients with ischemic nephropathy . Kidney Int 2006 ; 70 ( 5 ): 948 – 955 .
- Bax L , Mali WP , Van De Ven PJ , et al . Repeated intervention for in-stent restenosis of the renal arteries . J Vasc Interv Radiol 2002 ; 13 ( 12 ): 1219 – 1224 .
- N'Dandu ZM , Badawi RA , White CJ , et al . Optimal treatment of renal artery instent restenosis: repeat stent placement versus angioplasty alone . Catheter Cardiovasc Interv 2008 ; 71 ( 5 ): 701 – 705 .
- Stone PA , Campbell JE , Aburahma AF , et al . Ten-year experience with renal artery in-stent stenosis . J Vasc Surg 2011 ; 53 ( 4 ): 1026 – 1031 .
- Gray BH . Intervention for renal artery stenosis: endovascular and surgical roles . J Hypertens Suppl 2005 ; 23 ( 3 ): S23 – 29 .
- Lederman RJ , Mendelsohn FO , Santos R , et al . Primary renal artery stenting: characteristics and outcomes after 363 procedures . Am Heart J 2001 ; 142 ( 2 ): 314 – 323 .
- Shammas NW , Kapalis MJ , Dippel EJ , et al . Clinical and angiographic predictors of restenosis following renal artery stenting . J Invasive Cardiol 2004 ; 16 ( 1 ): 10 – 13 .
- Chi YW , White CJ , Thornton S , Milani RV . Ultrasound velocity criteria for renal in-stent restenosis . J Vasc Surg 2009 ; 50 ( 1 ): 119 – 123 .
- Otah KE , Alhaddad IA . Intravascular ultrasound-guided cutting balloon angioplasty for renal artery stent restenosis . Clin Cardiol 2004 ; 27 ( 10 ): 581 – 583 .
- Kakkar AK , Fischi M , Narins CR . Drug-eluting stent implantation for treatment of recurrent renal artery in-stent restenosis . Catheter Cardiovasc Interv 2006 ; 68 ( 1 ): 118 – 122 ; discussion 123–124.
- Douis H , Shabir S , Lipkin G , Riley P . Drug-eluting stent insertion in the treatment of in-stent renal artery restenosis in three renal transplant recipients . J Vasc Interv Radiol 2008 ; 19 ( 12 ): 1757 – 1760 .
- Silverman SH , Exline JB , Silverman LN , Samson RH . Endovascular brachytherapy for renal artery in-stent restenosis . J Vasc Surg 2014 ; 60 ( 6 ): 1599 – 1604 .
- Lookstein RA , Talenfeld AD , Raju R , et al . Sirolimus-eluting stent placement for refractory renal artery in-stent restenosis: sustained patency and clinical benefit at 24 months . Vasc Med 2009 ; 14 ( 4 ): 361 – 364 .
- Kiernan TJ , Yan BP , Eisenberg JD , et al . Treatment of renal artery in-stent restenosis with sirolimus-eluting stents . Vasc Med 2010 ; 15 ( 1 ): 3 – 7 .
