Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease: A Prospective 2-Center Cohort Study

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DOI

  • Mark Reinhard
  • Karoline Schousboe, University of Southern Denmark
  • ,
  • Ulrik B. Andersen, University of Copenhagen
  • ,
  • Niels Henrik Buus
  • Jesper Moesgaard Rantanen, Aalborg University
  • ,
  • Jesper Nørgaard Bech
  • Hossein Mohit Mafi, Aarhus University
  • ,
  • Sten Langfeldt
  • ,
  • Arindam Bharadwaz
  • ,
  • Arne Hørlyck
  • Mogens Kærsgaard Jensen
  • ,
  • Jørgen Jeppesen, University of Copenhagen
  • ,
  • Michael Hecht Olsen, University of Copenhagen, University of Southern Denmark
  • ,
  • Ib Abildgaard Jacobsen, University of Southern Denmark
  • ,
  • Bo Martin Bibby
  • Kent Lodberg Christensen

Background The aim of this study was to prospectively evaluate the effects of renal artery stenting in consecutive patients with severe atherosclerotic renal artery stenosis and high-risk clinical presentations as defined in a national protocol developed in 2015. Methods and Results Since the protocol was initiated, 102 patients have been referred for revascularization according to the following high-risk criteria: severe renal artery stenosis (≥70%) with true resistant hypertension, rapidly declining kidney function, or recurrent heart failure/sudden pulmonary edema. At baseline, the mean 24-hour ambulatory systolic blood pressure was 166.2 mm Hg (95% CI, 162.0-170.4), the defined daily dose of antihypertensive medication was 6.5 (95% CI, 5.8-7.3), and the estimated glomerular filtration rate was 41.1 mL/min per 1.73m2 (95% CI, 36.6-45.6). In 96 patients with available 3-month follow-up data, mean 24-hour ambulatory systolic blood pressure decreased by 19.6 mm Hg (95% CI, 15.4-23.8; P<0.001), the defined daily dose of antihypertensive medication was reduced by 52% (95% CI, 41%-62%; P<0.001), and estimated glomerular filtration rate increased by 7.8 mL/min per 1.73m2 (95% CI, 4.5-11.1; P<0.001). All changes persisted after 24 month follow-up. Among 17 patients with a history of hospitalization for acute decompensated heart failure, 14 patients had no new episodes after successful revascularization. Conclusions In this prospective cohort study, we observed a reduction in blood pressure and antihypertensive medication, an increase in estimated glomerular filtration rate, and a decrease in new hospital admissions attributable to heart failure/sudden pulmonary edema after renal artery stenting. Registration URL: https://clinicaltrials.gov. Identifier: NCT02770066.

Original languageEnglish
Article numbere024421
JournalJournal of the American Heart Association
Volume11
Issue7
ISSN2047-9980
DOIs
Publication statusPublished - 5 Apr 2022

    Research areas

  • atherosclerotic renal artery stenosis, atherosclerotic renovascular disease, flash pulmonary edema, rapid loss of kidney function, renal revascularization, resistant hypertension

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