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Results of renal artery revascularization in the post-ASTRAL era with 4 years mean follow-up.

Journal article
Authors Karin Zachrisson
Ferid Krupic
Mikael Svensson
Ann Wigelius
Andreas Jonsson
Angeliki Dimopoulou
Anna Stenborg
Gert Jensen
Hans Herlitz
Anders Gottsäter
Mårten Falkenberg
Published in Blood pressure
Pages 1-6
ISSN 1651-1999
Publication year 2020
Published at Institute of Medicine, School of Public Health and Community Medicine
Institute of Clinical Sciences, Department of Radiology
Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Clinical Sciences, Department of Orthopaedics
Pages 1-6
Language en
Links dx.doi.org/10.1080/08037051.2020.17...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Health Care Service and Management, Health Policy and Services and Health Economy

Abstract

Purpose: To investigate contemporary results of percutaneous transluminal renal angioplasty (PTRA).Materials and Methods: A multicentre retrospective study analysing all patients treated with PTRA for primary symptomatic renal artery stenosis (RAS) between 2010 and 2013 at four tertiary centres. Procedures during the preceding four years were counted to evaluate for change in PTRA frequency.Results: The number of PTRA procedures decreased by approximately 50% from 2006 to 2013. Patients treated in the post-ASTRAL period (n = 224) had a significant reduction in mean systolic pressure (168 to 146 mmHg, p < 0.01), diastolic pressure (84 to 76 mmHg, p < 0.01), number of anti-hypertensive drugs (3.54 to 3.05, p < 0.01), and anti-hypertensive treatment index (21.75 to 16.92, p < 0.01) compared to before PTRA. These improvements were maintained at one year and at the last clinical evaluation after a mean follow-up of 4.31 years. Renal function increased transiently without sustained improvement, or deterioration, during later follow-up. Thirteen patients (5.8%) eventually required dialysis, nine of these had eGFR <20 ml/min/1.73 m2 before PTRA. There was no difference in outcomes between subgroups differentiated by different indications for PTRA.Conclusion: The frequency of PTRA has decreased, indicating a higher threshold for invasive treatment of RAS in recent years. The reduction in blood pressures, the reduced need for anti-hypertensive medication, and stabilization of renal function over time suggest a clinical benefit for most patients who are now being treated with PTRA.

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