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Renal Stenting
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A renal stent involves a procedure called angioplasty where a catheter is inserted through your blood vessels and a tiny little mesh tube (the stent) is put in place to keep it open.
Embolic Protection ? Its Role in Carotid, Coronary and Renal Intervention
The end-organ consequences of arteriosclerosis, namely heart attack, stroke and renal failure, are the leading cause of mortality and morbidity in the western world. Advances in percutaneous interventional techniques have meant that a fair proportion of this disease burden can be dealt with by percutaneous and nonsurgical options. Coronary angioplasty is an established way of dealing with simple and increasingly complex coronary disease. Carotid and renal stenting are also gaining favor as the preferred treatment options, compared to either medical therapy or surgical treatment. Overall, the endovascular approach to treating increasingly complex arterial atherosclerosis is increasing. As the use of stenting increases, so the drive to reduce potential complications and improve success rates intensifies. Although embolization from local atheroma has long been recognized as a potential complication in vascular surgery, direct evidence of this phenomenon was also observed during saphenous vein graft angioplasty. There is also evidence that similar embolization also occurs during carotid and renal stenting, and in certain native coronary lesions with a high thrombus burden. This review examines the rationale for the use of embolic protection systems during endovascular intervention and the clinical evidence base for their use. We also describe the different types of embolic protection systems currently available, their relative merits and outline recommendations for the current use of these devices.
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A Review of the Prevention and Management of Catastrophic Complications During Renal Artery Stenting
Renal artery rupture, renal artery dissection or aortic dissection may follow stent deployment. Renal Artery Dissection The creation of a renal artery dissection during stenting that results in a change in management of the patient is unusual. Renal Artery Rupture Renal artery rupture is one of the most feared, though fortunately, rare complications with renal artery stenting with a reported incidence of only 0?1.7%.
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The Role of Embolic Protection Devices in Renal Angioplasty and Stenting
Purpose. A renal artery stenosis is frequent and usually caused by atherosclerosis. Renal artery angioplasty and stenting (RAAS) is now the first treatment to be proposed, giving good immediate and long-term results. But one concern is the postprocedural deterioration of the renal function, which may occur in 20?40% of the patients, and therefore limits the immediate benefits of the technique. Atheroembolism seems to play an important role. We postulated that the use of renal embolic protection devices could reduce the risk of renal embolism and avoid deterioration of the renal function. Methods. In 105 hypertensive patients (M:72), mean age: 65.4 ± 11.7 years (22?87) with atherosclerotic renal artery stenosis (18 bilateral), 124 RAAS were performed under protection. Nine patients had solitary kidneys and 38 had renal insufficiency. We used occlusion balloons (n = 46) or filters (n = 78), which allow a continuous flow. We recently experimented with a new filter (FiberNet®), which can capture particles of 30?40 microns without compromising the flow. Generated debris were removed and analyzed. Blood pressure and serum creatinine levels were followed. Results. Immediate technical success was 100%. Of the lesions, 96/124 were stented directly. Visible debris were aspirated with Percusurge from all patients and removed with filters in 80% of the cases (100% with FiberNet). Mean particle number: 98.1 ± 60.0. Mean diameter: 201 ± 76 (38?6206). Mean occlusion time: 6.55 ± 2.46 min (Percusurge). Mean time in situ (filters): 4.2 ± 1.1 min. With the FiberNet, five times more particles were removed. We observed one acute renal function (RF) deterioration. Mean follow-up: 18.2 ± 8 months. Mean creatinine level remained constant during follow-up. At 6 months follow-up in 91 patients, 69 patients had stabilized, 21 with baseline renal insufficiency improved and there was only one RF deterioration (1.1%) in a patient with moderate renal insufficiency. At 2 years, 54 patients were stabilized, 19
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Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy and Treat Renal Insufficiency in Patients wth Peripheral Arterial Disease
Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy and Treat Renal Insufficiency in Patients wth Peripheral Arterial Disease Feature: Automated Contrast Injection and Targeted Renal Therapy: Strategies to Prevent Contrast-Induced Nephropathy and Treat Renal Insufficiency in Patients wth Peripheral Arterial Disease - David E. Allie, MD, Chris J. Herbert, RT, RCIS, and Craig M. Walker, MD It is currently estimated that in the United ...
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Stabilization of Renal Function Following Renal Artery Stent Revascularization
This study evaluates the effect of renal artery stenting on renal function in 72 consecutive patients. Baseline renal function was considered ?abnormal? if creatinine was >= 1.5 mg/dl. ?Improvement? was defined as decrease in creatinine by >= 20%, ?unchanged? if variation was <= 20%, and "worse" if creatinine increased by >= 20%. Two patients (2/72 = 2.8%) had in-hospital death. Follow-up creatinine was available in 61/70 (87%) patients at 21 ± 11 months (9 patients lost to follow-up). Forty-four (44/61, 72%) patients had normal baseline creatinine that remained ?unchanged? in 42/44 (95%, p = ns). Seventeen (17/61, 28%) patients had "abnormal" baseline creatinine. The renal function ?improved? in 3/17 (18%), from 2.7 ± 1 to 1.6 ± 0.6 mg/dl (p = 0.06). Creatinine remained "unchanged" in 9/17 (53%), and was ?worse? in 5/17 (29%, 2.0 ± 0.51 to 3.3 ± 0.34 mg/dl, p = 0.005). In conclusion, the renal function remained stable in 89% of patients and worsened in 11% of patients at 21 months (follow-up available in 87% of the eligible patients) following renal artery stenting. In patients with baseline renal insufficiency (serum creatinine > 1.5 mg/dl), the renal function remained stable in 71% of patients. Reprinted with permission from J INVAS CARDIOL 2004;16:703?706
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Technical Considerations for Renal Artery Stenting
Renal artery stenosis (RAS) is the most common secondary cause of hypertension. It is associated with progressive renal failure. Percutaneous transluminal renal angioplasty and stenting (PTRAS) is associated with improved blood pressure control and preservation of renal function. PTRAS is associated with a high technical success rate and an acceptable adverse event and restenosis rate. Embolization and restenosis limit the benefit of this procedure, and are areas of future clinical research. After PTRAS, patients should be followed clinically and with duplex ultrasonography.
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