Risks and benefits of renal artery stenting in fibromuscular dysplasia: Lessons from the ARCADIA-POL study.

Autor:	Kądziela J; Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland., Jóźwik-Plebanek K; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland., Pappaccogli M; Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.; Department of Medical Sciences, Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Turin, Italy., van der Niepen P; Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel (VUB), Brussels, Belgium., Prejbisz A; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland., Dobrowolski P; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland., Michałowska I; Department of Radiology, National Institute of Cardiology, Warsaw, Poland., Talarowska P; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland., Warchoł-Celińska E; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland., Stryczyński Ł; Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland., Krekora J; Department of Cardiology, Medical University of Łódź, Łódź, Poland., Andziak P; 2nd Second Department of Vascular Surgery and Angiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Internal Affairs, Warsaw, Poland., Szczerbo-Trojanowska M; Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland., Maciąg R; 2nd Department of Radiology, Medical University of Warsaw, Warsaw, Poland., Sterliński I; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland.; Medical University of Warsaw, Warsaw, Poland., Witkowski A; Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland., Januszewicz A; Department of Hypertension, National Institute of Cardiology, Warsaw, Poland., Adlam D; Department of Cardiovascular Sciences and Leicester NIHR Biomedical Research Centre, Glenfield Hospital, Leicester University, Leicester, UK., Januszewicz M; 2nd Department of Radiology, Medical University of Warsaw, Warsaw, Poland., Persu A; Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
Jazyk:	angličtina
Zdroj:	Vascular medicine (London, England) [Vasc Med] 2024 Feb; Vol. 29 (1), pp. 50-57. Date of Electronic Publication: 2023 Dec 12.
DOI:	10.1177/1358863X231210523
Abstrakt:	Introduction: Although renal stenting is the standard revascularization method for atherosclerotic renal artery stenosis (RAS) (FMD-RAS), stenting in fibromuscular dysplasia (FMD) RAS is usually limited to periprocedural complications of angioplasty and primary arterial dissection. The main aim of the study was to retrospectively analyze the immediate and long-term results of renal stenting versus angioplasty in patients with FMD. Methods: Of 343 patients in the ARCADIA-POL registry, 58 patients underwent percutaneous treatment due to FMD-RAS (in 70 arteries). Percutaneous transluminal renal angioplasty (PTRA) was performed as an initial treatment in 61 arteries (PTRA-group), whereas primary stenting was undertaken in nine arteries (stent-group). Stent-related complications were defined as: in-stent restenosis > 50% (ISR); stent fracture; under-expansion; or migration. Results: In the PTRA-group, the initial restenosis rate was 50.8%. A second procedure was then performed in 22 arteries: re-PTRA (12 arteries) or stenting (10 arteries). The incidence of recurrent restenosis after re-PTRA was 41.7%. Complications occurred in seven of 10 (70%) arteries secondarily treated by stenting: two with under-expansion and five with ISR. In the stent-group, stent under-expansion occurred in one case (11.1%) and ISR in three of nine stents (33.3%). In combined analysis of stented arteries, either primarily or secondarily, stent-related complications occurred in 11/19 stenting procedures (57.9%): three due to under-expansion and eight due to ISRs. Finally, despite several revascularization attempts, four of 19 (21%) stented arteries were totally occluded and one was significantly stenosed at follow-up imaging. Conclusion: Our study indicates that renal stenting in FMD-RAS may carry a high risk of late complications, including stent occlusion. Further observational data from large-scale registries are required. Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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