Renal fractional flow reserve: A hemodynamic evaluation of moderate renal artery stenoses

Subramanian, Rajesh, White, Christopher J., Rosenfield, Kenneth, Bashir, Riyaz, Almagor, Yaron, Meerkin, David and Shalman, Evgeny (2005) Renal fractional flow reserve: A hemodynamic evaluation of moderate renal artery stenoses. Catheterization and Cardiovascular Interventions, 64 4: 480-486. doi:10.1002/ccd.20318

Author Subramanian, Rajesh
White, Christopher J.
Rosenfield, Kenneth
Bashir, Riyaz
Almagor, Yaron
Meerkin, David
Shalman, Evgeny
Title Renal fractional flow reserve: A hemodynamic evaluation of moderate renal artery stenoses
Journal name Catheterization and Cardiovascular Interventions   Check publisher's open access policy
ISSN 1522-1946
Publication date 2005-04
Sub-type Article (original research)
DOI 10.1002/ccd.20318
Volume 64
Issue 4
Start page 480
End page 486
Total pages 7
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Language eng
Abstract The objective of this study was to perform a hemodynamic evaluation of moderate (50–90%) renal artery stenosis (RAS) under conditions of rest and maximum hyperemia. Identifying patients with RAS who have hemodynamically significant stenoses and are most likely to benefit from revascularization is clinically important. Current methods used to evaluate RAS, including angiography, have limitations. Physiologic evaluation of RAS may have a role in identifying patients with hemodynamically significant stenosis. Patients with suspected renovascular hypertension due to aorto-ostial RAS were included in the study. Hyperemia was induced by administration of intrarenal papavarine. Translesional pressure gradients were measured and renal fractional flow reserve (FFR) was calculated using a 0.014″ pressure guidewire. Thirteen patients and 14 arteries with moderately severe (50–90%) RAS were studied. The mean translesional pressure gradient rose from a baseline of 6.3 ± 3.9 to 17.5 ± 10.8 mm Hg with maximal hyperemia. The renal FFR ranged from 0.58 to 0.95. There was a poor correlation between angiographic stenosis measurement and the renal FFR (r = −0.18; P = 0.54) and the hyperemic translesional mean pressure gradient (r = 0.22; P = 0.44). There was an excellent correlation between renal FFR and the resting mean translesional pressure gradient (r = −0.76; P = 0.0016) and the hyperemic mean translesional pressure gradient (r = −0.94; P < 0.0001). Selective renal arterial papavarine administration induces maximum hyperemia, permitting the calculation of renal FFR in renal arteries with aorto-ostial stenoses. The renal FFR correlates well with other hemodynamic parameters of lesion severity, but poorly with angiographic measures of lesion severity.
Keyword renovascular
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, 10:29:33 EST