Angiographic index for angioplasty-treatable atheromatous renal artery stenosis

Abstract

The relative reduction of the lumen diameter by an atheromatous lesion (% diameter reduction) is generally used as an angiographic index for atheromatous renal artery stenosis (ARAS), but its association with the clinical outcome of angioplasty has not been sufficiently evaluated. This study aimed to identify an angiographic index(ices) that can be used to identify angioplasty-treatable ARAS. We evaluated the clinical outcome of angioplasty in 27 patients who had unilateral ARAS without renal insufficiency by assessing the reduction in systemic arterial blood pressure (BP) after angioplasty and examined its association with various angiographic indices. In the receiver operating characteristic analysis for BP reduction, the area under the curve was larger for the absolute value of the lumen diameter at the narrowest part of its constriction (the narrowest diameter), an angiographic index introduced in this study, than for % diameter reduction (0.770 vs. 0.731). At a 3-mm maximum threshold, the narrowest diameter identified cases with BP reduction; the sensitivity/specificity was 0.89/0.75 (p<0.001). Furthermore, the narrowest diameter correlated better than % diameter reduction with hemodynamic indices of ARAS. In conclusion, the narrowest diameter is an angiographic index that can effectively identity angioplasty-treatable ARAS in patients without renal insufficiency.