Percutaneous Transluminal Renal Angioplasty in Renovascular Hypertension Due to Atheroma or Fibromuscular Dysplasia

We attempted percutaneous transluminal renal angioplasty in 89 patients with hypertension and renal-artery stenosis (including 51 with atheromatous and 31 with fibromuscular stenoses) who were then followed for an average of 16 months (range, 4 to 40). Angioplasty was technically successful in 87 per cent of the fibromuscular stenoses and in 57 per cent of the unilateral atheromatous stenoses but in only 10 per cent of the bilateral atheromatous stenoses. After successful angioplasty, blood pressure was reduced to normal or improved in 93 per cent of the patients with fibromuscular dysplasia and in 84 per cent of the patients with atheromatous disease. Angiographic follow-up at an average of 21.8 months in 15 patients showed persistent relief of the stenoses and a 12 per cent average increase in kidney size. Renal angioplasty is effective for long-term control of hypertension in patients with renal-artery stenosis due to fibromuscular dysplasia or unilateral non-ostial atheroma. (N Engl J Med 1983; 309:274–9.) The recent introduction of percutaneous transluminal renal angioplasty (renal angioplasty) has stimulated interest in the possibility of improving or curing renovascular hypertension without running the risks of surgery. 1 , 2 Although there have been many previous reports on renal angioplasty, these have either described small numbers of patients or failed to analyze the data separately according to the cause of the lesion, and they have had relatively short follow-up periods. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Since renovascular hypertension is commonly caused by one of two different conditions — atheroma or fibromuscular dysplasia — it is important that the effects of angioplasty be analyzed according to the cause . . .