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Abstract：
BACKGROUND: In patients with renal artery stenosis, revascularization was seen as a mean to improve outcomes, but large studies failed to show significant benefit in general population. However, data on benefits of renal artery stenting in patients with high-risk features, such as rapidly declining renal function and cardiac destabilization syndromes, are limited, as they were excluded from trials. In this descriptive study, we aimed to evaluate short- and long-term outcomes in high-risk patients with renal artery stenosis, treated by angioplasty and stenting. We have retrospectively interrogated our local databases for renal artery percutaneous interventions; patients at high-risk (rapidly declining renal function; stable chronic renal failure and bilateral renal artery disease; severe hypertensive crisis) were selected for the current analysis.
RESULTS: Of 30 patients undergoing renal artery stenting, 18 patients were deemed \"high-risk.\" On short term, good in-hospital control of hypertension and cardiac stabilization were obtained in all patients. Renal function improved significantly only in patients admitted with rapidly declining renal function, with significant creatinine level fall from median 3.98 mg/dL to 2.02 mg/dL, p = 0.023. However, for the whole group, creatinine change was non-significant (- 0.12 mg/dL, p = NS). On the long term, five patients (27.8%) ended-up on chronic hemodialysis and six patients died (33.3%) after a median of 20 months. No death occurred during the first year after the procedure.
CONCLUSIONS: Percutaneous procedures are feasible and safe in patients with high-risk renal artery stenosis, especially in those with rapidly declining renal function, probably saving some of them from the immediate need for renal replacement therapy, but long-term results are negatively influenced by the precarious general and cardio-vascular status of these patients and by the pre-existing significant renal parenchymal disease, non-related to the renal artery stenosis.
RESULTS: Of 30 patients undergoing renal artery stenting, 18 patients were deemed \"high-risk.\" On short term, good in-hospital control of hypertension and cardiac stabilization were obtained in all patients. Renal function improved significantly only in patients admitted with rapidly declining renal function, with significant creatinine level fall from median 3.98 mg/dL to 2.02 mg/dL, p = 0.023. However, for the whole group, creatinine change was non-significant (- 0.12 mg/dL, p = NS). On the long term, five patients (27.8%) ended-up on chronic hemodialysis and six patients died (33.3%) after a median of 20 months. No death occurred during the first year after the procedure.
CONCLUSIONS: Percutaneous procedures are feasible and safe in patients with high-risk renal artery stenosis, especially in those with rapidly declining renal function, probably saving some of them from the immediate need for renal replacement therapy, but long-term results are negatively influenced by the precarious general and cardio-vascular status of these patients and by the pre-existing significant renal parenchymal disease, non-related to the renal artery stenosis.
摘要：
背景：在肾动脉狭窄患者中，血运重建被视为改善结果的手段，但大型研究未能显示对普通人群的显著益处。然而,关于高风险特征患者肾动脉支架术益处的数据，如迅速下降的肾功能和心脏失稳综合征，是有限的，因为他们被排除在试验之外。在这项描述性研究中，我们旨在评估肾动脉狭窄高危患者的短期和长期结局,通过血管成形术和支架置入治疗。我们回顾性地查询了我们当地的数据库，以进行肾动脉经皮介入治疗；选择高危患者（肾功能迅速下降；稳定的慢性肾功能衰竭和双侧肾动脉疾病；严重的高血压危象）进行当前分析。
结果：在接受肾动脉支架置入术的30例患者中，18例患者被认为是“高风险”。\"在短期内，所有患者均获得了良好的高血压和心脏稳定的院内控制.仅在肾功能迅速下降的患者中，肾功能明显改善。肌酐水平从中位数3.98mg/dL降至2.02mg/dL，p=0.023。然而,对于整个团队来说，肌酐变化无统计学意义（-0.12mg/dL，p=NS)。从长远来看，5例患者(27.8%)最终接受了慢性血液透析,6例患者在中位时间20个月后死亡(33.3%).手术后的第一年没有死亡。
结论：经皮手术对于高危肾动脉狭窄患者是可行和安全的，尤其是那些肾功能迅速下降的患者，可能使他们中的一些人免于立即需要肾脏替代治疗，但长期结果受到这些患者不稳定的全身和心血管状态以及预先存在的显著肾实质疾病的负面影响，与肾动脉狭窄无关。
结果：在接受肾动脉支架置入术的30例患者中，18例患者被认为是“高风险”。\"在短期内，所有患者均获得了良好的高血压和心脏稳定的院内控制.仅在肾功能迅速下降的患者中，肾功能明显改善。肌酐水平从中位数3.98mg/dL降至2.02mg/dL，p=0.023。然而,对于整个团队来说，肌酐变化无统计学意义（-0.12mg/dL，p=NS)。从长远来看，5例患者(27.8%)最终接受了慢性血液透析,6例患者在中位时间20个月后死亡(33.3%).手术后的第一年没有死亡。
结论：经皮手术对于高危肾动脉狭窄患者是可行和安全的，尤其是那些肾功能迅速下降的患者，可能使他们中的一些人免于立即需要肾脏替代治疗，但长期结果受到这些患者不稳定的全身和心血管状态以及预先存在的显著肾实质疾病的负面影响，与肾动脉狭窄无关。
