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Early duplex predicts late stenosis after renal artery angioplasty and stenting
Jason W. Christie, M.D., Thomas D. Conlee, M.D., Timothy E. Craven, Justin B. Hurie, M.D., Kimberly J. Hansen, M.D..
Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA.

Objectives: To examine the relationship between early duplex sonography and restenosis after primary renal artery percutaneous angioplasty and stenting (RA-PTAS).
Methods: Consecutive patients undergoing RA-PTAS for hemodynamically significant atherosclerotic renal artery stenosis (RAS) with hypertension and/or ischemic nephropathy between September 2003 and July 2010 were identified from a prospective registry. Patients had renal artery duplex ultrasound (RDS) pre RA-PTAS, within one week of RA-PTAS and follow-up serial exams post one week for surveillance for restenosis. Restenosis was defined as a renal artery PSV ≥ 180cm/s on follow-up RDS. Association between renal artery PSV and restenosis was examined using proportional hazards regression.
Results: RA-PTAS was performed on 187 renal arteries in 151 patients during the study period. Patients without RDS within the
first week post RA-PTAS or on follow-up and redo interventions were excluded. 100 RA-PTAS procedures in 91 patients (58% female; 11% non-white; mean age, 70±9.8 years; mean pre RA-PTAS PSV, 272±104cm/s) were included in the study. Mean follow-up time was 14.9 ± 10.8 months. Within one week of RA-PTAS mean renal artery
PSV differed significantly for renal arteries with and without recurrent stenosis (114 ± 27cm/s, 91±34cm/s respectively; P<0.001). Proportional hazards regression analysis demonstrated increased PSV on first post RA-PTAS RDS as predictive of recurrent disease (hazard ratio [HR] for 30cm/s increase, 1.83; 95% confidence interval [CI], 1.35-2.47; P<.0001). There was no difference in pre to post-op PSV change in those with and without stenosis on follow-up (169±102cm/s, 174±116cm/s respectively; P=.80). Multivariable associations between preoperative factors, first post-op PSV and follow up restenosis were examined using forward stepwise variable selection. Only first post-op PSV (HR for 30cm/s increase, 1.89; 95% CI, 1.40-2.57; P<0.0001) and bilateral repair (HR 0.19; 95% CI, 0.04-0.99; P=0.049) were selected as significant predictors. A receiver operating characteristic (ROC) curve was examined to assess ability of first week PSV after RA-PTAS to predict follow-up restenosis. Optimal renal artery PSV cut point was 107cm/s or greater to predict follow up restenosis. This value was associated with a sensitivity of 64.9%, specificity of 71.4%, and area under ROC curve of 70.4%.
Conclusions: Early renal artery PSV within one week after RA-PTAS predicts recurrent RAS. Recurrent stenosis demonstrated no association with the pre to post-op change in PSV.


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