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 RR14. Covered Stents Convey Improved Performance Over Bare-metal Stents for Atherosclerotic Renal Artery Stenosis

William B. Harris, Christopher Lesar, Larry R. Sprouse, Daniel Fisher, Mark Fugate, Michael Greer, Sachin Phade, Charles Joels, Jeffrey Horn
Vascular Surgery, University of Tennessee, Chattanooga, Chattanooga, TN.

OBJECTIVES: The endovascular management of atherosclerotic renal artery stenosis (RAS) has evolved over several decades. Endovascular therapy with stents (PTAS) often utilizes balloon-expandable bare-metal stents due to their radial force. However, restenosis frequently occurs. No studies have investigated the patency of covered stents in comparison to bare-metal stents in the treatment of RAS.
 
METHODS: We performed a retrospective chart review of 197 patients at our institution who underwent renal artery stenting for atherosclerotic RAS from 2005-2011. One hundred seventy-nine patients were included with a total of 206 stented renal arteries and 226 PTAS interventions. Index cases as well as first and second re-interventions were examined.
 
RESULTS: One hundred seventy-nine patients were included in the study with a total of 226 interventions performed with PTAS. Of these interventions, 195 were index (first) procedures. Twenty PTAS were in vessels that which had required 1 previous intervention and 11 PTAS were in vessels that required 2 previous interventions. The average follow-up was 30 months. Forty-eight vessels were treated with angioplasty and covered stents and 178 vessels were treated with angioplasty and bare-metal stents. Four of 48 (8.3%) in the covered stent group and 41 vessels of 178 (23%) in the bare-metal stent group developed restenosis requiring intervention. Primary patency for covered stents was 100% at 12 months and 93% at 24 months; bare metal stent patency was 83% at 12 months and 74% at 24 months. There was a statistical significance in patency in comparing covered stents to bare-metal stents with p<0.045 in the overall study.
 
CONCLUSIONS: While initial success was seen in treating RAS with bare-metal stents, covered stents confer increased primary patency and decreased need for repeat secondary interventions. Covered stents should be considered in renal artery stenting for both primary index procedures and secondary interventions due to their improved performance over bare-metal stenting for ostial RAS.
 
AUTHOR DISCLOSURES: D. Fisher: Atrium, Medtronic, Boston Scientific, Research grants; M. Fugate: Atrium, Medtronic, Boston Scientific, Research grants; Boston Scientific, Cordis, Consulting fees or other remuneration (payment); M. Greer: Atrium, Medtronic, Boston Scientific, Research grants; W. B. Harris: Nothing to disclose; J. Horn: Atrium, Medtronic, Boston Scientific, Research grants; C. Joels: Atrium, Medtronic, Boston Scientific, Research grants; C. Lesar: Atrium, Medtronic, Boston Scientific, Research grants; Cordis, Boston Scientific, CSI, Consulting fees or other remuneration (payment); S. Phade: Atrium, Medtronic, Boston Scientific, Research grants; L. R. Sprouse: Atrium, Medtronic, Boston Scientific, Research grants; Cordis, Boston Scientific, Consulting fees or other remuneration (payment).
 
Posted April 2013

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