Renal Stenting for Incidentally Discovered Renal Artery Stenosis: Is There any Outcome Benefit?

We evaluated whether there was a clinical outcome benefit in patients incidentally discovered to have high-grade renal artery stenosis (RAS) and treated with percutaneous transluminal renal angioplasty and stenting (PTRAS) at the time of angiogram for another indicated procedure. A retrospective chart review was performed on all patients undergoing renal arteriography over 4 years at our academic tertiary-care referral center. Review of catheterization reports was used to identify patients diagnosed with high-grade RAS (reduction of ≥70% luminal diameter by arteriogram). Patients treated with PTRAS were identified. Baseline and postprocedure blood pressure (BP, an average of at least three independent measurements), glomerular filtration rate, serum creatinine, and antihypertensive medication regimen were compared for 12 months of follow-up. Over 4 years, 124 patients underwent renal arteriography and 78 (63%) were diagnosed with high-grade RAS. Fifty-eight patients (74% of those with high-grade RAS) received PTRAS. Patients treated with PTRAS had similar baseline characteristics to those with high-grade RAS with no intervention, with the exception of lower diastolic BP (DBP; 74 ± 11.2 vs. 80 ± 14.2 mm Hg, p = 0.04) and a higher proportion of hyperlipidemia (78 vs. 55%, p = 0.05). Thirty-eight out of 58 PTRAS patients (66%) received sufficient follow-up to assess outcomes. When baseline and postprocedure variables were compared in PTRAS patients with 12-month follow-up, there was a reduction in systolic BP (SBP, 153 ± 20.8 vs. 136 ± 27.2 mm Hg, p = 0.01) and mean arterial pressure (MAP, 103 ± 11.2 vs. 95 ± 14 mm Hg, p = 0.04). When these patients were stratified by those with an increase, decrease, or no change in postprocedure antihypertensive medications, significant reductions in SBP, MAP, and DBP were noted only in the patient population that also had an increase in the number of antihypertensive medications. No differences in renal insufficiency were detected. Patients with high-grade RAS incidentally discovered during arteriography performed for extrarenal disease and treated with PTRAS have a modest reduction in BP, which is significant only in those patients with an increased number of antihypertensive medications postprocedure. Caution must be taken in stenting patients with incidental RAS as outcome benefit may be minimal when compared to medical management only.