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SIR 2025
Arterial Interventions
Scientific Session
Andrew Warfield, PhD (he/him/his)
Medical Student
University of Vermont Larner College of Medicine, United States
Christopher Morris, Division of Interventional Radiology, University of Vermont Medical Center
Professor of Radiology and Surgery at the Larner College of Medicine at the University of Vermont
Division of Interventional Radiology, University of Vermont Medical Center, United States
Anant Bhave, MD
Associate Professor
University of Vermont Medical Center, United States
Geoffrey Scriver, M.D.
Physician-Scientist
University of Vermont Medical Center, United States
Joseph Shields, MD
Associate Professor
University of Vermont Medical Center, United States
Varun Agrawal, MD
Associate Professor
University of Vermont Medical Center, United States
Richard Solomon, MD
Professor
University of Vermont Medical Center, United States
Bill Majdalany, MD, FSIR (he/him/his)
Associate Professor
University of Vermont Medical Center, United States
The Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial found no benefit to renal artery stenting (RASt) over medical therapy but excluded patients with medically resistant hypertension (mrHTN) or progressive loss of kidney function (plKF). We evaluated clinical response to RASt in these patients with a higher severity of disease.
Materials and Methods: An IRB approved, retrospective search for all patients that underwent RASt at a single institution from January 2004 through December 2023 was performed. Inclusion criteria were prior clinical evaluation for atherosclerotic renal artery stenosis, RASt of at least one renal artery, and underlying mrHTN or plKF. Exclusion criteria were imaging evidence of connective tissue disease, prior renal transplant, flash pulmonary edema, both systolic BP ≤ 135mmHg and diastolic BP ≤ 85mmHg pre-stent, absence of pre-stent evaluation, or lack of follow up. Demographics, indication, prior kidney imaging, and past medical history were collected. Blood pressure (BP), serum creatinine (Cr) and anti-hypertensive (AH) data were collected pre-stent and at 3 months (3 mo), 1 year (1 yr), 3 years (3 yr), and 5 years (5 yr) post RASt. Cr values were also collected both 1 yr, and 3 mo prior to RASt. For BP and Cr, up to four values were averaged at each time point. All data were analyzed using a mixed effects model with Dunnet’s Correction for multiple comparisons.
Results: 79 patients (34M/45F, 68.5±12.3 years) were identified. 48.1% (38/79) received RASt for mrHTN, 21.5% (17/79) for worsening Cr, and 30.4% (24/79) for both. Initial BP was 168.97±21.12/81.59±13.61 mmHg despite 3.39±1.31 AH. BP decreased following RASt; 143.09±16.38/74.1±11.58 at 3 mo, 141.98±19.69/70.79±9.96 at 1 yr, 135.9±17.8/70.94±9.09 at 3 yr, and 134.22±16.02/67.55±9.76 at 5 yr post RASt (p< 0.0001 for all). Number of AH medications also decreased from 3.39±1.31 pre-stenting to 2.61±1.43 (p< 0.0001) at 3 mo, 2.55±1.45 (p< 0.0001) at 1 yr, and 2.76±1.61 (p=0.0005) at 3 yr post-stenting. At 5 yr post-stenting AH burden returned to baseline (3.18±1.72, p=0.627). Cr showed an increasing trend 1 yr prior to RASt (1.63±0.58 to 2.1±1.29, p=0.0002) which was improved by RASt (1.89±0.98 (p=0.43) at 3 mo, 1.75±0.78 (p=0.18) at 1 yr, 1.71±0.78 (p=0.42) at 3 yr, and 1.73±0.79 (p=0.7855) at 5 yr post RASt. 5 patients were on dialysis prior to stent placement, 9 patients required dialysis post RASt, and 1 patient came off dialysis post RASt.
Conclusion: RASt effectively decreased BP as well as AH burden in patients with renovascular atherosclerotic mrHTN, while also stabilizing renal function.