Experience of stenting for atherosclerotic renal artery stenosis in a cardiac catheterization laboratory: Technical considerations and complications

BackgroundAtherosclerotic renal artery (RA) stenosis contributes to hypertension, renal insufficiency and end stage renal disease, and is independently associated with adverse cardiovascular events. Percutaneous renal intervention is efficacious in treating renovascular hypertension and may be effective in stabilizing or improving renal function, thereby reducing cardiovascular risk. However, high rates of procedural complications have been reported.ObjectivesTo determine the nature and frequency of complications of percutaneous renal intervention using contemporary techniques and equipment in a high-volume cardiac catheterization laboratory.MethodsConsecutive patients undergoing attempted RA stenting for atherosclerotic RA stenosis in the cardiac catheterization laboratory at the Vancouver General Hospital (Vancouver, British Columbia) between June 2000 and March 2007 were enrolled in a prospective registry. Baseline clinical characteristics, procedural and technical information, and complications were recorded.ResultsA total of 132 RAs were stented in 106 patients during 108 procedures. The procedural success rate was 100%, with no related death, myocardial infarction, nephrectomy or dialysis. Major complications included three pseudoaneurysms (2.8%) and acute deterioration in renal function in six patients (5.5%), although renal function returned to baseline in one patient at 12 months.ConclusionsRA stenting can be successfully and safely performed using contemporary techniques, and the low complication rates described should be the minimum standard for contemporary trials evaluating RA stenting.

HistoriqueLa sténose athéroscléreuse de l’artère rénale (AR) contribue à l’hypertension, à l’insuffisance rénale et à la maladie rénale terminale et elle est liée de manière indépendante à des complications cardiovasculaires. L’intervention rénale percutanée est efficace pour le traitement de l’hypertension rénovasculaire et pourrait contribuer à stabiliser ou à améliorer la fonction rénale, ce qui réduirait le risque cardiovasculaire, mais des taux élevés de complications ont été signalés lors des interventions.ObjectifsDéterminer la nature et la fréquence des complications de l’intervention rénale percutanée effectuée au moyen de techniques et d’équipements modernes dans un laboratoire de cathétérisme cardiaque achalandé.MéthodesDes patients consécutifs candidats à une pose d’endoprothèse