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Titolo:
TREATMENT OF ATHEROSCLEROTIC OSTIAL RENAL-ARTERY STENOSIS WITH THE INTRAVASCULAR STENT
Autore:
TUTTLE KR; CHOUINARD RF; WEBBER JT; DAHLSTROM LR; SHORT RA; HENNEBERRY KJ; DUNHAM LA; RAABE RD;
Indirizzi:
HEART INST SPOKANE,122 W 7TH AVE,SUITE 230 SPOKANE WA 99204 SACRED HEART MED CTR SPOKANE WA 00000
Titolo Testata:
American journal of kidney diseases
fascicolo: 4, volume: 32, anno: 1998,
pagine: 611 - 622
SICI:
0272-6386(1998)32:4<611:TOAORS>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
TRANS-LUMINAL ANGIOPLASTY; RENOVASCULAR HYPERTENSION; PALMAZ STENT; WALLSTENT ENDOPROSTHESIS; FOLLOW-UP; PLACEMENT; RECONSTRUCTION; INSUFFICIENCY; MANAGEMENT; RESTENOSIS;
Keywords:
RENAL ARTERY STENOSIS; INTRAVASCULAR STENT; ATHEROSCLEROSIS; OSTIAL LESION; HYPERTENSION; RENAL FUNCTION;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
36
Recensione:
Indirizzi per estratti:
Citazione:
K.R. Tuttle et al., "TREATMENT OF ATHEROSCLEROTIC OSTIAL RENAL-ARTERY STENOSIS WITH THE INTRAVASCULAR STENT", American journal of kidney diseases, 32(4), 1998, pp. 611-622

Abstract

Traditional approaches to revascularization for atherosclerotic ostial renal artery stenosis (RAS) have been suboptimal because of the invasiveness and relatively high perioperative morbidity and mortality of surgery and the low rates of success and long-term patency with percutaneous renal angioplasty (PTRA). We report our 5-year (1991 to 1996) experience with the intravascular stent (Palmaz stent; Johnson & Johnson, Miami Lakes, FL) for the treatment of ostial RAS in 129 patients (63 men, 66 women) and 148 arteries. The mean age of the patients was 71+/- 10 years; 98% were hypertensive and 57% had renal dysfunction. Angiographic characteristics of RAS were unilateral in 78%, bilateral in15%, and single kidney in 7%. The technical success rates were 98% for stent versus 11% for PTRA in the ostial location. The stent restenosis rate (angiographic) was 14% at 8 +/- 5 months. Systolic and diastolic blood pressures were as follows: baseline, 158 +/- 3 and 84 +/- 2 mm Hg; 6 months, 149 +/- 3 and 81 +/- 2 mm Hg; 12 months, 149 +/- 3 and79 +/- 2 mm Hg; and 24 months, 135 +/- 3 and 79 +/- 2 mm Hg. Follow-up values were significantly lower than baseline (P < 0.05). The numberof medications for hypertension Initially decreased from 2.2 +/- 0.1 at baseline to 1.6 +/- 0.1 and 1.8 +/- 0.1 at 1 and 3 months, respectively (P < 0.05). By 6 months, however, the number of medications had increased and was not significantly different from before stent placement. Renal function was stable in the group as a whole: Cockroft-Gault creatinine clearance (C-G CrCl) at baseline was 40 +/- 2 mL/min; at 6 months, 36 +/- 3 mL/min; at 12 months, 39 +/- 3 mL/min; and at 24 months, 39 +/- 4 mL/min. When stratified by degree of renal function, values were similarly stable. Patients with a baseline serum creatinine level of 2 mg/dL or less had C-G CrCl values as follows: baseline, 53 +/- 3 mg/dL; 6 months, 43 +/- 4 mg/dL; 12 months, 46 +/- 4 mg/dL; and 24months, 52 +/- 5 mg/dL. Those with a baseline serum creatinine level greater than 2 mg/dL had C-G CrCl values as follows: baseline, 26 +/- 2 mg/dL; 6 months, 31 +/- 4 mg/dL; 12 months, 32 +/- 6 mg/dL; and 24 months, 23 +/- 3 mg/dL. Of eight patients who were dialysis dependent, four (50%) recovered renal function with a mean serum creatinine levelof 2.3 +/- 0.5 mg/dL at 15 +/- 6 months (range, 9 to 24 months). Stent placement for the treatment of atherosclerotic ostial RAS has a highsuccess rate and a low rate of restenosis. Control of hypertension improves in most patients, Renal function stabilizes or improves in the majority of patients, even those with severe renal failure. These favorable outcomes are maintained long term. (C) 1998 by the National Kidney Foundation, Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/07/20 alle ore 09:00:33