Treatment of atheromatous renal artery in-stent restenosis in 51 patients

Abstract Objective To evaluate our treatment of renal artery in-stent restenosis. Patients and methods Monocentric retrospective study of 53 cases of restenosis and two occlusions in 51 patients detected via systematic follow-up with imaging (72.5%) and/or deterioration of kidney function (5.9%) and/or blood pressure failure (54.9%), 15.7 months (5–121) after implantation, giving rise to 49 recalibrations via a balloon and five additional stentings. Analysis of the technical results, the effects on blood pressure and kidney function after repeated revascularizations. Results Secondary permeability of 38 arteries (63.2%) after 12.4 months (3–64) with 14 second restenoses; 33.3% after redilation with a balloon, 60% after renewed stenting, more common in smokers ( P = 0.02), in case of peripheral arterial disease ( P = 0.02), ostial location ( P = 0.049) and kidney function impairment at the time of diagnosis of the restenosis ( P = 0.012). After 12.7 months (3–64) post-revascularization, kidney function was improved in 30% of patients and stabilised in 50% of patients. Treatment of second restenoses: one failure (7.1%), nine dilations with a balloon, three cutting balloon, one second stent. Treatment of third restenoses: 71.4% treated with a balloon (2), cutting balloon (2) or coated stent (DES) (1); then permeability at a later point in time: 50%. Conclusion The treatment of repeated restenoses with conventional techniques is of imperfect efficacy, and currently remains un-codified.