Embolic Protection Devices in Patients with Renal Artery Stenosis with Chronic Renal Insufficiency: A Clinical Study

Purpose

To present clinical outcomes with the use of embolic protection devices (EPDs) and renal artery stents in patients with chronic renal insufficiency (CRI) and renal artery stenosis (RAS).

Materials and Methods

A retrospective study was conducted in 23 patients with RAS and CRI who were treated with renal artery stent placement with an EPD. Follow-up data were obtained through medical records.

Results

In 23 patients (18 men; 78%) with an average age of 69.4 years ± 11 (range, 46–86 y), 32 renal arteries were treated for worsening renal function (n = 17; 74%) or uncontrolled hypertension and worsening renal function (n = 6; 26%). Nine FilterWire EZ devices were used in eight patients (35%) and 17 SpideRX devices were used in 15 patients (65%). The average follow-up was 8 months ± 5. After the stent procedure, the mean systolic blood pressure decreased significantly (P < .05) whereas the diastolic pressure remained unchanged. There was a significant increase in the mean estimated glomerular filtration rate from 32.9 mL/min ± 12.9 at baseline to 41.3 mL/min ± 13.7 at last follow-up (P < .05). In 96% of patients, there was improvement or stabilization of kidney function. In six of the 17 SpideRX devices (35%), macroscopically evident embolic material was observed in the device after stent placement. There were two minor and two major complications.

Conclusions

Renal artery stent placement combined with the use of a SpideRX or FilterWire EZ device is associated with an good clinical outcome with a reasonable safety profile.

Abbreviations: CRI, chronic renal insufficiency, eGFR, estimated glomerular filtration rate, EPD, embolic protection device, K-DOQI, Kidney Disease Outcome and Quality Initiative, RAS, renal artery stenosis