Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: Angioplasty versus stent placement
Introduction
Takayasu arteritis is a granulomatous inflammation of unknown etiology that involves large and medium sized elastic arteries resulting in stenosis and occlusion. Takayasu arteritis affects young patients and shows life-long course with recurrence and progression of symptoms and complications.
Renovascular hypertension from renal artery involvement, which may be refractory to medical treatment, is known as a major prognostic factor and a cause of premature death [1], [2]. Although surgical revascularization of renal artery shows good long term patency [3], [4], [5], endovascular treatment is preferred as an initial treatment. Percutaneous transluminal renal angioplasty is established treatment [6], [7], [8] and most widely used, but stenting has a limited role for hemodynamically significant residual stenosis or flow-limiting dissection as a bail-out procedure [9]. Although there have been many studies reporting the results of endovascular treatment of renal artery stenosis in Takayasu arteritis, there has been none comparing the long-term results of angioplasty and stenting. In this study, we described and compared the long-term follow-up results of renal angioplasty and stenting with focus on patency of renal artery and clinical effects on hypertension.
Section snippets
Patients
Between August 1995 and July 2005, 16 patients (14 females and 2 males; age ranging from 16 to 58 years, median: 32.5 years) with renovascular hypertension caused by Takayasu arteritis underwent endovascular treatment for 22 stenotic lesions of renal arteries. The diagnosis of Takayasu arteritis was based on the criteria modified by Sharma et al. [10]. Hypertension was defined as systolic pressure ≥ 140 mmHg, disastolic ≥ 90 mmHg or the use of antihypertensive drug [11]. All patients had hypertension
Results
Technical success rate was 95.4% (21/22 renal arteries) without major complication (Fig. 1). The mean diameter of balloon in angioplasty was 5.3 ± 0.82 mm and the mean diameter of stent was 5.9 ± 1.1 mm.
In one patient (patient 8) with technical failure, residual stenosis after angioplasty was more than 50% of diameter after repeated and prolonged dilatation with a high-pressure balloon. Her contralateral renal artery was normal. Stent placement was not attempted at that time and her blood pressure
Discussion
Several reports have shown excellent results of angioplasty in renovascular hypertension caused by Takayasu arteritis. Tyagi et al. [6] reported cure rate of 44.2% and improvement rate of 48.4% with restenosis rate of 13.5%. Sharma et al. [7] reported that angioplasty was beneficial in 89% of patients and that restenosis rate was 16%. Their studies were the series with follow-up period around two years. Our study is the series with the longest follow-up period, 10 years in average, to date.
Conclusion
We represented long-term comparative study of angioplasty and stent in renal artery stenosis caused by Takayasu arteritis. Restenosis rate was 8% in angioplasty and 66% in stent placement. Patency rates of renal arteries were 100%, 91.7%, 91.7% in angioplasty alone and primary unassisted and primary assisted patency rates were 55.6%, 33.3%, 33.3% and 88.9%, 66.7%, 55.6% in stent placement at 1-, 3- and 5-years, respectively. Clinical outcome on hypertension did not differ between patients
Acknowledgment
We thank Ms. Siunna Baek for her editing assistance.
References (23)
- et al.
Renal revascularization in Takayasu arteritis-induced renal artery stenosis
Journal of Vascular Surgery
(2004) - et al.
Balloon angioplasty for renovascular hypertension in Takayasu's arteritis
American Heart Journal
(1993) - et al.
Results of renal angioplasty in nonspecific aortoarteritis (Takayasu disease)
Journal of Vascular and Interventional Radiology
(1998) - et al.
Diagnostic criteria for Takayasu arteritis
International Journal of Cardiology
(1996) - et al.
Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial
Lancet
(1999) - et al.
Long-term endothelial dysfunction after coronary artery stenting
American College of Cardiology
(1999) - et al.
Stent supported angioplasty in Takayasu arteritis
International Journal of Cardiology
(1998) - et al.
A follow-up study of balloon angioplasty and de-novo stenting in Takayasu arteritis
International Journal of Cardiology
(2000) - et al.
Current status of Takayasu arteritis in India
International Journal of Cardiology
(1996) - et al.
Natural history of aortoarteritis (Takayasu's disease)
Circulation
(1989)
Long-term outcome for 120 Japanese patients with Takayasu's arteritis: clinical and statistical analyses of related prognostic factors
Circulation
Cited by (49)
Occluded renal artery and a contralateral moderate renal artery stenosis – Which side should be treated?
2023, Annals of Vascular Surgery - Brief Reports and InnovationsOutcomes of Percutaneous Intervention in Patients With Takayasu Arteritis
2023, Journal of the American College of CardiologyDrug-Coated Balloon Angioplasty for Carotid Artery Occlusion Caused by Takayasu Arteritis
2020, Annals of Vascular SurgeryComparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis
2020, International Journal of CardiologyCitation Excerpt :The result should be interpreted with caution due to the small sample size. Previous literature advocated that vascular procedures in TA patients should be reserved for remission period whenever possible since intervention in the active phase may produce poor outcomes [38–40]. Similarly, coronary intervention may also be avoided during the active phase, unless the presence of an acute life-threatening condition outweighs the risk of intervention [41].
Surgery and Endovascular Management in Patients With Takayasu's Arteritis: A Ten-Year Retrospective Study
2020, Annals of Vascular Surgery