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CLINICAL RESEARCH: RENAL ARTERY STENOSIS

Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements

Bernard De Bruyne, MD, PhD^_*,_*, Ganesh Manoharan, MD^_*, Nico H.J. Pijls, MD, PhD, Katia Verhamme, MD, PhD, Juraj Madaric, MD^_*, Jozef Bartunek, MD, PhD^_*, Marc Vanderheyden, MD^_* and Guy R. Heyndrickx, MD, PhD^_*

^_* Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
Pharmaco-Epidemiology Unit, Department of Medical Informatics, Erasmus MC, Rotterdam, the Netherlands.

Manuscript received March 9, 2006; revised manuscript received May 5, 2006, accepted May 22, 2006.

^_* Reprint requests and correspondence: Dr. Bernard De Bruyne, Cardiovascular Center, Aalst Onze-Lieve-Vrouw Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium. (Email: bernard.de.bruyne{at}olvz-aalst.be).

OBJECTIVES: The purpose of this study was to define "significant" renal artery stenosis (i.e., a stenosis able to induce arterial hypertension).

BACKGROUND: The degree of renal artery stenosis that justifies an attempt at revascularization is unknown.

METHODS: In 15 patients, transstenotic pressure measurements were obtained before and after unilateral stenting. After stenting, graded stenoses were created in the stented segment by progressive inflation of a balloon catheter. Stenosis severity was expressed as the ratio of distal pressure (P_d ) corrected for aortic pressure (P_a ). Balloon inflation pressure was adjusted to create 6° of stenosis (P_d /P_a from 1.0 to 0.5, each step during 10 min). Plasma renin concentration was measured at the end of each step in the aorta and in both renal veins.

RESULTS: For a P_d /P_a ratio >0.90, no significant change in plasma renin concentration was observed. However, when P_d /P_a became <0.90, a significant increase in renin was observed in the renal vein of the stenotic kidney, finally reaching a maximal increase of 346 ± 145% for P_d /P_a of 0.50 (p = 0.006). These values returned to baseline when the stenosis was relieved. In addition, plasma renin concentration increased significantly in the vein from the non-stenotic kidney (p = 0.02).

CONCLUSIONS: In renal artery stenoses, a P_d /P_a ratio of 0.90 can be considered a threshold value below which the stenosis is likely responsible for an up-regulation of renin production and, thus, for renovascular hypertension. These findings might contribute to better patient selection for renal angioplasty.

Abbreviations and Acronyms   Pa = mean aortic pressure   Pd = mean pressure distal to the renal artery stenosis

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