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Home > Vascular Annual Meeting > PP10. Preoperative Clinical Determinants of Response...

PP10. Preoperative Clinical Determinants of Response to Renal Artery Stenting: Who Will Benefit?

J. Gregory Modrall, Carlos H. Timaran, Bart L. Dolmatch, G. Patrick Clagett, Clayton Trimmer
University of Texas Southwestern Medical Center, Dallas, TX

OBJECTIVES: Renal artery stenting (RAS) is the most common method of treating symptomatic renal artery stenosis despite few evidence-based guidelines to aid in patient selection. The goal of this study was to identify predictors of blood pressure (BP) and renal function response that will aid in patient selection for RAS.

METHODS: The clinical outcomes of 149 patients who underwent primary RAS between 2000 and 2008 were examined. A modification of AHA guidelines defined individual patient responses to RAS: 1) BP responders=BP<160/90 on a reduced number of anti-hypertensive medications (MEDS) or reduction in diastolic BP to <90 mm Hg on the same MEDS; 2) Renal function responders = =20% increase in eGFR. Median follow-up was 19 months.

RESULTS: As a group, the cohort had a significant decrease in systolic and diastolic BP with RAS (baseline vs. follow-up systolic BP: 155.6±2.5 vs. 139.7±2.3 mm Hg, p<0.0001; baseline vs. follow-up diastolic BP: 79.1±1.5 mm Hg vs. 72.3±1.1 mm Hg, p<0.0001) with no change in MEDS (median number of MEDS at baseline vs. follow-up: 3 vs. 3, p=0.95). The cohort had no change in renal function with RAS (median creatinine [CR] at baseline vs. follow-up: 1.4 vs. 1.3 mg/dL, p=0.50). Using rigorous criteria to determine individual responses to RAS, only 48 of 149 (32.2%) patients were BP responders and 22 of 149 (14.8%) patients were renal function responders. Logistic regression analysis identified the number of baseline MEDS (Odds Ratio [OR] 4.0, 95%CI 2.4-6.7, p<0.0001) and diastolic BP=90 mm Hg (OR 13.3, 95%CI 4.0-44.0; p<0.0001) as independent predictors of a positive BP response. The BP response rate, stratified by number of MEDS, is provided (Table 1) to assist with patient selection for RAS. Preoperative CR=1.5 mg/dL was the only independent predictor of renal function response (OR 5.3, 95%CI 1.7-16.6; p=0.004), although only 23.0% of patients with a CR=1.5 mg/dL were renal function responders.

CONCLUSIONS: These data suggest that patient selection for RAS may be guided by the number of MEDS, diastolic BP, and CR.

AUTHOR DISCLOSURES: J. Modrall, None; C.H. Timaran, None; B.L. Dolmatch, Bard; Bard, Endovascular Forum; Bard; G. Clagett, None; C. Trimmer, None.

Table 1.