Elsevier

European Journal of Radiology

Volume 82, Issue 11, November 2013, Pages 1913-1918
European Journal of Radiology

Long term results of endovascular treatment in renal arterial stenosis from Takayasu arteritis: Angioplasty versus stent placement

https://doi.org/10.1016/j.ejrad.2013.06.019Get rights and content

Abstract

Purpose

To retrospectively evaluate and compare the long term patency and antihypertensive effect of angioplasty and stent insertion in renal artery stenosis caused by Takayasu arteritis, with CT angiography and clinical follow-up.

Materials and methods

We retrospectively analyzed and compared effects on hypertension and patency of renal artery in 16 patients (age ranging from 16 to 58 years, mean: 32.1 years) with renovascular hypertension caused by Takayasu arteritis who underwent endovascular treatment including angioplasty (n = 13) and stent placement (n = 9) for 22 stenotic renal arteries.

Results

Technical success was 95% (21/22) without major complications. In the last follow-up CT angiogram (mean 85 ± 41 months), restenosis was 8% (1/12) in angioplasty and 66% (6/9) in stent. Patency rates of angioplasty were 100%, 91.7%, 91.7% and primary unassisted and primary assisted patency rates of stent placement were 55.6%, 33.3%, 33.3% and 88.9%, 66.7%, 55.6% at 1-, 3- and 5-years, respectively. In clinical follow-up (mean 120 ± 37.8 months, range 48–183 months), beneficial effects on hypertension were obtained in 87% of patients (13/15) and there was no significant difference between the patients who were treated by only angioplasty and the patients who received stent placement in at least one renal artery, regardless of whether or not angioplasty had been performed in the other renal artery.

Conclusion

Compared with stent placement, angioplasty demonstrated better long term patency and similar clinical benefit on renovascular hypertension in renal artery stenosis of Takayasu arteritis. We suggest that stent placement should be reserved for obvious angioplasty failure.

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)

  • K. Ishikawa et al.

    Long-term outcome for 120 Japanese patients with Takayasu's arteritis: clinical and statistical analyses of related prognostic factors

    Circulation

    (1994)
  • Cited by (49)

    • Outcomes of Percutaneous Intervention in Patients With Takayasu Arteritis

      2023, Journal of the American College of Cardiology
    • Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis

      2020, International Journal of Cardiology
      Citation 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].

    View all citing articles on Scopus
    View full text