Factors affecting outcome after percutaneous renal artery stent insertion.

Background: Renal artery stenosis is increasingly being treated with the percutaneous insertion of stents. Little data are available to help select patients most likely to derive benefit from the procedure.

Methods: Data were gathered on all patients treated with renal artery stent insertion at the Royal Melbourne Hospital prior to 1998, and who were followed-up for at least 6 months or until death. Multivariate regression analysis was used to identify factors associated with patient survival and renal survival (survival free of dialysis).

Results: Adequate data were available on 148 of 198 patients treated during this time (75%). A baseline creatinine over 0.15 mmol/L and age over 70 were strongly associated with worse patient survival (Likelihood ratio(LR) 9.96, p < 0.0001 and 3.4, p = 0.001 respectively) and renal survival (LR 7.8, p < 0.001 and 2.7, p < 0.01 respectively). The presence of diabetes was also associated with worse overall survival (LR 2.2, p < 0.05) but not renal survival, while the presence of another nephropathic disorder was associated with worse renal survival (LR 2.8, p < 0.01) but not overall survival. The use of ACE inhibitors after the stenting procedure was associated with a significantly better renal survival (LR 0.46, p < 0.05).

Conclusions: Patients with baseline renal impairment, older age, diabetes or another coexistent renal disease have poor outcomes after renal artery stent insertion. A relatively conservative approach to revascularisation may be preferable in these patient groups. The use of ACE inhibitors after stent insertion is associated with a reduced likelihood of death or dialysis.