Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: Renal fractional flow reserve

Mitchell, Jason A., Subramanian, Rajesh, White, Christopher J., Soukas, Peter A., Almagor, Yaron, Stewart, Richard E. and Rosenfield, Kenneth (2007) Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: Renal fractional flow reserve. Catheterization and Cardiovascular Interventions, 69 5: 685-689. doi:10.1002/ccd.21095


Author Mitchell, Jason A.
Subramanian, Rajesh
White, Christopher J.
Soukas, Peter A.
Almagor, Yaron
Stewart, Richard E.
Rosenfield, Kenneth
Title Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: Renal fractional flow reserve
Journal name Catheterization and Cardiovascular Interventions   Check publisher's open access policy
ISSN 1522-1946
1522-726X
Publication date 2007-04-01
Sub-type Article (original research)
DOI 10.1002/ccd.21095
Volume 69
Issue 5
Start page 685
End page 689
Total pages 5
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background: Renal stent placement improves or cures hypertension in only 60–70% of patients with renal artery stenosis (RAS) and uncontrolled hypertension. There is a need to better identify patients who are likely to respond to percutaneous renal revascularization. We investigated whether an abnormal renal fractional flow reserve (FFR) would predict blood pressure improvement in patients undergoing renal artery stent placement. Methods: We prospectively enrolled 17 patients with unilateral RAS and medically refractory hypertension (BP > 140/90 mm Hg). Renal FFR was measured at maximal hyperemia induced by papaverine followed by renal stent placement. Blood pressure improvement was defined as a blood pressure of ≤140/90 mm Hg or an absolute decrease in diastolic blood pressure by 15 mm Hg on the same or less number of medications. Patients not meeting the above criteria were nonresponders. Results: Renal stent placement was successful in all patients. The average follow-up was 10 ± 2 months. In patients with an abnormal renal FFR (< 0.80) blood pressure improved at 90 days in 86% compared with 30% in the normal renal FFR group (P = 0.04). Translesional pressure gradients (resting, peak, or hyperemic) alone failed to differentiate blood pressure responders from nonresponders. Conclusions: Renal FFR is a promising tool to identify patients likely to benefit following renal stent placement. This finding was independent of translesional pressure gradients, which did not predict blood pressure improvement. The ability to segregate patients with RAS and coexisting hypertension from those with renovascular hypertension may help clinicians select patients most likely to benefit from revascularization.
Keyword Peripheral vascular disease
Renovascular hypertension
Renal stent
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Mon, 14 Mar 2011, 10:25:00 EST