The impact of renal artery stenting on therapeutic aims

Edgar, B. et al. (2023) The impact of renal artery stenting on therapeutic aims. Journal of Human Hypertension, 37(4), pp. 265-272. (doi: 10.1038/s41371-022-00785-8) (PMID:36526895) (PMCID:PMC10063438)

Abstract

Renal artery stenosis manifests as poorly-controlled hypertension, impaired renal function or pulmonary oedema, therefore the success of treatment is dependent on indication. This study aims to determine the outcomes of patients undergoing renal artery stenting (RASt) based on therapeutic aim compared to criteria used in the largest randomised trial. Retrospective case-note review of patients undergoing RASt between 2008–2021 (n = 74). The cohort was stratified by indication for intervention (renal dysfunction, hypertension, pulmonary oedema) and criteria employed in the CORAL trial, with outcomes and adverse consequences reported. Intervention for hypertension achieved significant reduction in systolic blood pressure and antihypertensive agents at 1 year (median 43 mmHg, 1 drug), without detrimental impact on renal function. Intervention for renal dysfunction reduced serum creatinine by a median 124 μmol/L, sustained after 6 months. Intervention for pulmonary oedema was universally successful with significant reduction in SBP and serum creatinine sustained at 1 year. Patients who would have been excluded from the CORAL trial achieved greater reduction in serum creatinine than patients meeting the inclusion criteria, with equivalent blood pressure reduction. There were 2 procedure-related mortalities and 5 procedural complications requiring further intervention. 5 patients had reduction in renal function following intervention and 7 failed to achieve the intended therapeutic benefit. Renal artery stenting is effective in treating the indication for which it has been performed. Previous trials may have underestimated the clinical benefits by analysis of a heterogenous population undergoing a procedure rather than considering the indication, and excluding patients who would maximally benefit.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kingsmore, Prof David and Delles, Professor Christian and Rostron, Dr Maggie and Hussey, Keith and Gillis, Dr Keith and Geddes, Dr Colin and Pearson, Robert and Roditi, Dr Giles and Kasthuri, Dr Ram and Brady, Dr Adrian
• Authors: Edgar, B., Pearson, R., Kasthuri, R., Gillis, K., Geddes, C., Rostron, M., Brady, A., Hussey, K., Roditi, G., Delles, C., and Kingsmore, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Human Hypertension
• Publisher: Springer Nature
• ISSN: 0950-9240
• ISSN (Online): 1476-5527
• Published Online: 16 December 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Journal of Human Hypertension 37(4): 265-272
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303944		BHF Centre of Excellence	Colin Berry	British Heart Foundation (BHF)	RE/18/6/34217	CAMS - Cardiovascular Science