Restenosis after renal artery angioplasty and stenting: incidence and risk factors.
Restenosis after renal artery angioplasty and stenting: incidence and risk factors.
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DOI：
10.1016/j.jvs.2009.05.019
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发表时间：
2009-10
影响因子：
4.3
通讯作者：
Hansen, Kimberley J.
中科院分区：
文献类型：
--
作者：
Corriere, Matthew A.;Edwards, Matthew S.;Pearce, Jeffrey D.;Andrews, Jeanette S.;Geary, Randolph L.;Hansen, Kimberley J.
采用直接肾动脉经皮血管成形术和支架植入术（RA-PTAS）管理肾动脉狭窄（RAS）与围手术期死亡和重大并发症的低风险相关;然而，在一部分患者中发生再狭窄，可能需要重复干预。我们研究了RA-PTAS后再狭窄的发生率及其与临床因素的关系。在2003年10月至2007年9月期间，从一项登记研究中确定了因血流动力学显著的动脉粥样硬化RAS（与高血压或缺血性肾病或两者相关）而接受RA-PTAS的患者。使用多普勒超声（DUS）成像将恢复定义为介入后肾动脉收缩期峰值流速（PSV）≥180 cm/s。再狭窄的发生率和时间分布采用基于治疗肾脏的生存分析进行分析。采用比例风险回归分析了临床因素与复发性狭窄之间的关系。在研究期间，对112个动脉粥样硬化RAS肾脏进行了RA-PTAS。初始介入后肾动脉DUS成像证实101个肾脏的PSV <180 cm/s，这构成了本分析的基础。12个月时估计无再狭窄生存率为50%，18个月时为40%。再狭窄风险降低与术前他汀类药物使用（风险比[HR]，0.35; 95%置信区间[CI]，0.16-0.74; P = 0.006）和术前舒张压升高（DBP; HR，术前DBP每升高10 mm Hg，0.70; 95% CI，0.49-0.99; P = 0.049）相关。评估的其他因素均与再狭窄无关。在大量接受RA-PTAS治疗的患者中发生缓解。术前使用他汀类药物和术前DBP升高与再狭窄风险降低相关。在没有禁忌症的情况下，他汀类药物应被视为动脉粥样硬化性肾动脉狭窄患者的标准治疗。
Management of renal artery stenosis (RAS) with primary renal artery percutaneous angioplasty and stenting (RA-PTAS) is associated with a low risk of periprocedural death and major complications; however, restenosis develops in a subset of patients and repeat intervention may be required. We examined the incidence of restenosis after RA-PTAS and associations with clinical factors. Consecutive patients undergoing RA-PTAS for hemodynamically significant atherosclerotic RAS associated with hypertension or ischemic nephropathy, or both, between October 2003 and September 2007 were identified from a registry. Restenosis was defined using duplex ultrasound (DUS) imaging as a renal artery postintervention peak systolic velocity (PSV) ≥180 cm/s. The incidence and temporal distribution of restenosis was analyzed using survival analysis based on treated kidneys. Associations between clinical factors and recurrent stenosis were examined using proportional hazards regression. RA-PTAS was performed on 112 kidneys for atherosclerotic RAS during the study period. Initial postintervention renal artery DUS imaging confirming PSV <180 cm/s in 101 kidneys, which formed the basis of this analysis. Estimated restenosis-free survival was 50% at 12 months and 40% at 18 months. Decreased risk of restenosis was associated with preoperative statin use (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.16–0.74; P = .006) and increased preoperative diastolic blood pressure (DBP; HR, 0.70 per 10-mm Hg increase in preoperative DBP; 95% CI, 0.49–0.99; P = .049). No other factors assessed were associated with restenosis. Restenosis occurs in a substantial number of patients treated with RA-PTAS. Preoperative statin medication use and increased preoperative DBP are associated with reduced risk of restenosis. In the absence of contraindications, statins should be considered standard therapy for patients with atherosclerotic renal artery stenosis.
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影响因子：
4.3
作者：
HANSEN, KJ;TRIBBLE, RW;DEAN, RH
通讯作者：
DEAN, RH
影响因子：
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作者：
Edwards, MS;Craven, TE;Hansen, KJ
通讯作者：
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影响因子：
2.6
作者：
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通讯作者：
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影响因子：
19.7
作者：
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通讯作者：
Man in't Veld, AJ
影响因子：
4.3
作者：
Nolan, BW;Schermerhorn, ML;Cronenwett, JL
通讯作者：
Cronenwett, JL