肾动脉支架术治疗双侧肾动脉狭窄

Invasive Strategy in Patients with Bilateral Renal Artery Stenosis

目的探讨双侧肾动脉狭窄的介入治疗策略。方法46例严重双侧肾动脉狭窄患者(内径减少>70%),其中16例接受双侧肾动脉支架术(组Ⅰ),30例仅于狭窄严重侧置入支架(组Ⅱ)。记录两组手术成功率,并比较随访结果。结果组Ⅰ和组Ⅱ的造影剂用量分别为(135.4±9.1)mL和(97.5±10.5)mL(P<0.05);两组手术成功率和围手术期造影剂肾病发生率无显著差异(P>0.05)。随访期两组血压改善结果相似,组Ⅰ肾功能衰竭、再次入院和死亡率均高于组Ⅱ,但并无统计学差异(P>0.05)。结论对双侧肾动脉狭窄患者可能仅需行严重侧肾动脉支架术治疗。

Objective To determine the invasive strategy for patients with bilateral renal atery stenosis （BRAS）. Methods Among 46 consecutive patients with severe bilateral renal artery stenosis （BRAS） （ luminal narrowing 〉70% ） undergoing renal artery stenting, 16 patients were treated with bilateral renal stenting （group Ⅰ）, while the 30 remaining patients received unilateral stent implantation for the more stentic renal artery （group Ⅱ）. The successful rates of the both groups were recorded and the outcomes during follow-up were compared. Results The average dose of contrast medium was significantly higher in group Ⅰ than in group Ⅱ, （135.4±9.1 ） mL vs. （97.5±10.5） mL（P〈0.05）. However, the incidence of contrast nephropathy was similar in both groups. During follow-up, group Ⅰ patients tended to have more renal failure, re-admission and deaths than those in group Ⅱ, but it did not reach significantly statistical level. The rate of improvement of hypertension was also similar in both groups. Conclusion The strategy of implantation one stent in the more severe side of BRAS appears to be better than renal stenting in both sides.