SP064Renovacular Hypertensión treated with Percutaneous revascularization: STENT Restenosis and double antiplatelet therapy Time

Abstract

INTRODUCTION: Renovascular hypertension (RVH) is currently considered one of the most prevalent and important causes of secondary hypertension and renal organ damage. The prevalence of RVH in hypertensive patients increases more than 40% in elderly, comorbid and ateromatosis patients. Randomized controlled trials have not shown the superiority of Percutaneous revascularization (PR) versus optimal medical treatments for patients suffering from Atherosclerotic Renovascular Disease (ARVD). For patients who have undergone percutaneous revascularization (PR), the optimal timing of antiplatelet therapy after PR, has not been well described in the literature METHODS: We conducted a retrospective study including 31 patients (Median age 69.6 years IR: 43-88; Males 51.6%) with Resistant hypertension who were diagnosed of Atherosclerotic renovascular hypertension (RVH) by angioTC and renal arteriography. All of them underwent percutaneous revascularization by angioplasty plus stent placement. Patients were stratified into two groups according to time of antiplatelet therapy with Aspirin 100mg and Clopidrogrel 75mg. Group I: Double antiplatelet therapy for <3months. Group II: Double antiplatelet therapy between 6 months and 1 year. All patients continued with single antiplatelet therapy at the end of the double antiplatelet therapy period and all were followed during a mean + SD of 3.7±3.9 years. Clinical, analytical and demographic data were collected, as well as cardiovascular risk factor and number of antihypertensive drugs. Similarly, blood pressure and kidney function were measured before and after the procedure RESULTS: Eight patients had stent restenosis in Group I (47%), and 3 patients in Group II (21%), P= 0,100. No differences in blood pressure between two groups were observed (SBP/DBP before PR and Post procedure in group I were 185.8/100.5mmHg and 120.3/71,4mmHg and 182.6/94.6mmHg and 121.4/75.5mmHg in group II. P=N/S. The numbers of antihypertensive drugs was similar in group I and group II. A stable renal function was observed previously, and one year after treatment. There was an improvement in blood pressure after PR (SBP/DBP 186/97 to 118/72 mmHg, p<0.001) and a reduction of antihypertensive drugs were observed in both groups (5 vs 3 p<0.05). CONCLUSIONS: In our study, a longer time of antiaggregation was not associated with greater stent permeability in renal arteries, so randomized studies are necessary to know the optimal time of dual antiplatelet therapy in patients undergoing renal RP to avoid restenosis.