Management of renovascular disease: a review of renal artery stenting in ten studies
Management of renovascular disease: a review of renal artery stenting in ten studies
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DOI：
10.1093/qjmed/92.3.159
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发表时间：
1999-03-01
影响因子：
13.3
通讯作者：
Hill, D
中科院分区：
文献类型：
--
作者：
Isles, CG;Robertson, S;Hill, D
为了评价肾动脉支架在肾血管疾病中的有效性和安全性，我们确定了10项描述性研究，其中包含足够的系统评价信息。未发现支架置入术与血管成形术或手术的随机比较。总的来说，379例患者的416条肾动脉中放置了支架，平均年龄64岁（范围27-84岁），56%为男性。在狭窄中，97%为动脉粥样硬化（研究间范围71-100%），80%为开口部（22-100%），31%为双侧（12-87%）。支架植入术的临床适应症通常是高血压伴或不伴轻度肾损害。支架植入术的影像学适应症为：血管成形术时弹性回缩（58%）或夹层（2%）导致的狭窄大于或等于50%（9/10项研究）;血管成形术后一段时间的再狭窄（15%）;或作为初次手术（25%）。96-100%的手术报告了技术成功。在312/416（75%）支动脉中评价的缓解（大于或等于50%狭窄），通常在6 - 12个月之间，总体为16%。在34/379例（9%）患者和34/207例（16%）最初肾功能正常的患者中，高血压通过支架植入术治愈（未治疗时DBP ≤ 90 mmHg）。379例患者中有6例（1.6%）在支架植入后30天内死亡，但只有2例（0.5%）死亡被判定为与手术相关。除导致透析的并发症外，42/379例（13%）患者发生并发症，三分之一需要干预，从输血到外科搭桥手术。根据血清肌酐浓度（SCC）判断，在最初肾功能受损（SCC >133 μ mol/l）的患者中，26%的患者肾功能改善，48%稳定，26%恶化。在一项研究中，平均基线SCC >200 μ mol/l，当肾功能事先恶化时，成功的支架植入术可以减缓肾衰竭的进展速度。9/379例（2.4%）患者，包括7/14例（50%）最初SCC大于或等于400 μ mol/l的患者，在支架植入后需要透析。支架植入术应由专科中心作为血管成形术失败或血管成形术后再狭窄的二次手术，提供给患有肾血管疾病和不受控制的高血压、进展性肾衰竭或肺水肿的患者。
To evaluate the efficacy and safety of renal artery stents in renovascular disease, we identified 10 descriptive studies containing sufficient information for systematic evaluation. No randomized comparisons of stenting with angioplasty or with surgery were found. Overall, stents were placed in 416 renal arteries in 379 patients, mean age 64 years (range 27-84), 56% male. Of the stenoses, 97% were atheromatous (inter-study range 71-100%), 80% ostial (22-100%) and 31% bilateral (12-87%). The clinical indication for stenting was usually hypertension with or without mild renal impairment. Radiological indications for stenting were: narrowing of greater than or equal to 50% (in 9/10 studies) as a result of elastic recoil (58%) or dissection (2%) at the time of angioplasty; restenosis some time after angioplasty (15%); or as a primary procedure (25%). Technical success was reported in 96-100% of procedures. Restenosis (greater than or equal to 50% narrowing), evaluated in 312/416 (75%) arteries, generally between 6 and 12 months, was 16% overall. Hypertension was cured by stenting (DBP less than or equal to 90 mmHg on no treatment) in 34/379 (9%) overall and in 34/207 (16%) of those whose renal function was normal initially. Six of 379 (1.6%) patients died within 30 days of stenting, but in only two (0.5%) was death judged to be procedure-related. Complications, other than those which led to dialysis, occurred in 42/379 (13%) patients, one third requiring intervention, ranging from blood transfusion to a surgical bypass procedure. Renal function as judged by serum creatinine concentration (SCC) improved in 26%, stabilized in 48% and deteriorated in 26% of patients whose renal function was impaired initially (SCC >133 mu mol/l). In one study, with average baseline SCC >200 mu mol/l, successful stenting slowed the rate of progression of renal failure when renal function was deteriorating beforehand. Nine of 379 (2.4%) patients, including 7/14 (50%) whose SCC was greater than or equal to 400 mu mol/l initially, required dialysis after stenting. Stenting should be offered by specialist centres as a secondary procedure for unsuccessful angioplasty, or restenosis following angioplasty, to patients with renovascular disease and uncontrolled hypertension, advancing renal failure or pulmonary oedema.