Prediction of Hypertension Improvement After Stenting of Renal Artery StenosisComparative Accuracy of Translesional Pressure Gradients, Intravascular Ultrasound, and Angiography
Massoud A. Leesar, MD*,*,
Jai Varma, MD*,
Adam Shapira, MD*,
Ibrahim Fahsah, MD*,
Seyed T. Raza, MD ,
Ziad Elghoul, MD*,
Anthony C. Leonard, PhD ,
Karthikeyan Meganathan, MS and
Sohail Ikram, MD*
* Division of Cardiology, University of Louisville, Louisville, Kentucky
Jewish Hospital Heart and Lung Institute, Louisville, Kentucky
Department of Public Health Sciences, University of Cincinnati, Cincinnati, Ohio
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Figure 1 A Representative Example of Quantitative Renal Angiography, IVUS Analysis, and TPG Is Shown in a Study Patient With RAS
The reference diameter (RD) and reference lumen area (RLA) from the reference segment (C) as well as minimum lumen diameter (MLD) and minimum lumen area (MLA) from the stenotic segment (A) were selected for both quantitative angiographic and intravascular ultrasound (IVUS) analyses. Panel B is the segment with post-stenotic dilation. Quantitative renal angiography demonstrates that the diameter stenosis (DS) of the renal artery is 57%. IVUS area stenosis (AS) and hyperemic systolic gradient (HSG) are 72% and 31 mm Hg, respectively, and both are indicative of significant renal artery stenosis (RAS). FFR = fractional flow reserve; LA = lumen area; LD = lumen diameter; RSG = resting systolic gradient; TPG = translesional pressure gradient.
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Figure 2 Receiver-Operating Characteristic Curves of HSG, FFR, IVUS, and Diameter Stenosis for Hypertension Improvement
The ROC curve for (A) HSG; (B) FFR; (C) IVUS area stenosis (AS); and (D) diameter stenosis by quantitative angiography (QRA DS). ROC = receiver-operating characteristic; other abbreviations as in Figure 1.
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Figure 4 Number of Antihypertensive Medications and Serum Creatinine Levels at Baseline and Follow-Up Among Patients With an HSG  21 Versus <21 mm Hg
(A) The numbers of antihypertensive medications were similar at baseline. During follow-up, the number of antihypertensive medications was significantly lower in RAS with an HSG 21 mm Hg than with HSG <21 mm Hg. (B) Serum creatinine levels were not significantly different between the groups either at baseline or during follow-up. Abbreviations as in Figure 1.
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