Factors influencing the need for target vessel revascularization after renal artery stenting

Purpose: To provide additional insight into factors that may be associated with the need for target vessel revascularization (TVR) following de novo renal artery stenting during long-term follow-up. Methods: A retrospective chart and database review was conducted to analyze the progress of all patients with de novo symptomatic renal artery stenosis who underwent stent-supported angioplasty under the auspices of the Single Operator, Single Center, Renal Stent Retrospective Study (SOCRATES). The records review identified 782 patients who were enrolled in the study between 1993 and 2004; after excluding 34 (4.5%) patients (lost to follow-up or inadequate data), 748 consecutive patients (412 women; mean age 70.7 +/- 9.7 years, range 37-92) were suitable for longitudinal analysis. The need for TVR was based on strict clinical criteria (>= 20% rise in serum creatinine, worsening hypertension, and/or recurrent flash pulmonary edema), and all patients underwent multidisciplinary evaluation before stenting and during follow-up. Results: Follow-up spanned a mean 45.8 +/- 26.5 months. TVR was needed in 88 (10.03%) of 877 arteries and was best predicted by patient age <= 67 years (OR 2.91, p = 0.0001), stent diameter <= 5.0 mm (OR 2.31, p = 0.001), solitary functioning kidney (OR 2.01, p = 0.048), history of lower extremity peripheral artery disease (OR 1.87, p = 0.008), and antecedent history of stroke (OR 1.73, p = 0.026). Conclusion: Renal artery stenting appears to be durable, with only 10% of stented arteries requiring TVR during clinically-based long-term follow-up. Arteries with a final stent diameter <= 5.0 mm were more than twice as likely to need TVR, as were patients with a solitary kidney. The authors acknowledge that clinical recurrence is not a surrogate for ultrasound surveillance after renal artery stenting, so prospective controlled trials will be needed to determine risk factors for restenosis.