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Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements

Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements Bernard De Bruyne, Ganesh Manoharan, Nico H. J. Pijls, Katia Verhamme, Juraj Madaric, Jozef Bartunek, Marc Vanderheyden, Guy R. Heyndrickx To define “significant” renal artery stenosis, graded stenoses were created by pro...

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Published in:Journal of the American College of Cardiology 2006-11, Vol.48 (9), p.1851-1855
Main Authors: De Bruyne, Bernard, Manoharan, Ganesh, Pijls, Nico H.J., Verhamme, Katia, Madaric, Juraj, Bartunek, Jozef, Vanderheyden, Marc, Heyndrickx, Guy R.
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description Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements Bernard De Bruyne, Ganesh Manoharan, Nico H. J. Pijls, Katia Verhamme, Juraj Madaric, Jozef Bartunek, Marc Vanderheyden, Guy R. Heyndrickx To define “significant” renal artery stenosis, graded stenoses were created by progressive balloon inflation after stenting of a mild renal stenosis. Stenosis was expressed as the ratio of distal pressure (Pd) to aortic pressure (Pa). Renin was measured in the aorta and in both renal veins. For a Pd/Paratio >0.90, renin did not increase. Only for Pd/Pa
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J. Pijls, Katia Verhamme, Juraj Madaric, Jozef Bartunek, Marc Vanderheyden, Guy R. Heyndrickx To define “significant” renal artery stenosis, graded stenoses were created by progressive balloon inflation after stenting of a mild renal stenosis. Stenosis was expressed as the ratio of distal pressure (Pd) to aortic pressure (Pa). Renin was measured in the aorta and in both renal veins. For a Pd/Paratio &gt;0.90, renin did not increase. Only for Pd/Pa&lt;0.90 was an increase in renin observed in the renal vein of the stenotic kidney. Renal artery stenoses with a Pd/Paratio &lt;0.90 trigger the production of renin and are, therefore, likely to be responsible for renovascular hypertension. The purpose of this study was to define “significant” renal artery stenosis (i.e., a stenosis able to induce arterial hypertension). The degree of renal artery stenosis that justifies an attempt at revascularization is unknown. 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 (Pd) corrected for aortic pressure (Pa). Balloon inflation pressure was adjusted to create 6° of stenosis (Pd/Pafrom 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. For a Pd/Paratio &gt;0.90, no significant change in plasma renin concentration was observed. However, when Pd/Pabecame &lt;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 Pd/Paof 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). In renal artery stenoses, a Pd/Paratio 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. 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J. Pijls, Katia Verhamme, Juraj Madaric, Jozef Bartunek, Marc Vanderheyden, Guy R. Heyndrickx To define “significant” renal artery stenosis, graded stenoses were created by progressive balloon inflation after stenting of a mild renal stenosis. Stenosis was expressed as the ratio of distal pressure (Pd) to aortic pressure (Pa). Renin was measured in the aorta and in both renal veins. For a Pd/Paratio &gt;0.90, renin did not increase. Only for Pd/Pa&lt;0.90 was an increase in renin observed in the renal vein of the stenotic kidney. Renal artery stenoses with a Pd/Paratio &lt;0.90 trigger the production of renin and are, therefore, likely to be responsible for renovascular hypertension. The purpose of this study was to define “significant” renal artery stenosis (i.e., a stenosis able to induce arterial hypertension). The degree of renal artery stenosis that justifies an attempt at revascularization is unknown. 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 (Pd) corrected for aortic pressure (Pa). Balloon inflation pressure was adjusted to create 6° of stenosis (Pd/Pafrom 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. For a Pd/Paratio &gt;0.90, no significant change in plasma renin concentration was observed. However, when Pd/Pabecame &lt;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 Pd/Paof 0.50 (p = 0.006). These values returned to baseline when the stenosis was relieved. 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J. Pijls, Katia Verhamme, Juraj Madaric, Jozef Bartunek, Marc Vanderheyden, Guy R. Heyndrickx To define “significant” renal artery stenosis, graded stenoses were created by progressive balloon inflation after stenting of a mild renal stenosis. Stenosis was expressed as the ratio of distal pressure (Pd) to aortic pressure (Pa). Renin was measured in the aorta and in both renal veins. For a Pd/Paratio &gt;0.90, renin did not increase. Only for Pd/Pa&lt;0.90 was an increase in renin observed in the renal vein of the stenotic kidney. Renal artery stenoses with a Pd/Paratio &lt;0.90 trigger the production of renin and are, therefore, likely to be responsible for renovascular hypertension. The purpose of this study was to define “significant” renal artery stenosis (i.e., a stenosis able to induce arterial hypertension). The degree of renal artery stenosis that justifies an attempt at revascularization is unknown. 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 (Pd) corrected for aortic pressure (Pa). Balloon inflation pressure was adjusted to create 6° of stenosis (Pd/Pafrom 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. For a Pd/Paratio &gt;0.90, no significant change in plasma renin concentration was observed. However, when Pd/Pabecame &lt;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 Pd/Paof 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). In renal artery stenoses, a Pd/Paratio 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>17084261</pmid><doi>10.1016/j.jacc.2006.05.074</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Angioplasty
Blood Pressure - physiology
Cardiology
Cardiovascular disease
Catheterization - methods
Coronary vessels
Female
Flow velocity
Humans
Hypertension
Hypertension, Renovascular - diagnosis
Hypertension, Renovascular - physiopathology
Intubation
Male
Medical imaging
Patients
Plasma
Renal Artery Obstruction - diagnosis
Renal Artery Obstruction - physiopathology
Severity of Illness Index
Ultrasonography, Doppler, Color - methods
title Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements
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