ESTENOSIS ARTERIA RENAL

• INCIDENCIA: 0.5-5%• HTA REFRACTARIA: <10-15%• MAYOR RX DE ACV, CCI Y SOBREVIDA MENOR

ASTRAL (ANGIOPLASTYAND STENTING FOR RENAL ARTERY LESIONS) TRIAL27

Seriouscomplications associated with revascularization occurred in 23 patients, including2 deaths and 3 amputations of toes or limbs.

STAR (STENT PLACEMENT AND BLOOD PRESSUREAND LIPID-LOWERING FOR THE PREVENTION OFPROGRESSION OF RENAL DYSFUNCTION CAUSED BY ATHEROSCLEROTIC OSTIAL STENOSIS OF THE RENAL ARTERY)

Undeniable indications for revascularization

(Am Heart J 2009;158:154-62.)

(Am Heart J 2009;158:154-62.)

• Hemodynamically significant asymptomatic (incidental) RAS (is defined as:

1. 50% to 70% diameter stenosis by visual estimation with a peak translesional gradient (measured with a ≤5F catheter or pressure wire) of 20 mm Hg or higher or a mean gradient of 10 mm Hg orhigher; OR

2. any stenosis with 70% or larger diameter by visual estimation; OR3. stenosis with 70% or larger diameter by intravascular ultrasound measurement

• HTA resistente: HTA CON TTO MAS DE TRES DROGAS A DOSIS MAXIMA Q INCLUYE UN DIURETICO

• HTA ACELERADA: SUBITO Y RAPIDO DETERIORO.

• HTA CON DAÑO AGUDO DE UN ORGANO: IRA, INS CARD AGUDA; NUEVo DISTURBIO NEUROLOGICO U OFTALMOLOGICO .Y /O GRADO IIi/IV DE RETINOPATIA.

• noted that the National Kidney Foundation defines chronic kidney disease as a decrease in estimated glomerular filtration rate to less than 60 mL/min per 1.73 m2 (modified Modification of Diet in Renal Disease formula) that persists for at least 3 months

• Studios with a baseline serum creatinine between 1.5 and 4.0 mg per dL (751). • Several factors may argue against

– proteinuria greater than 1 g every 24 hours renal atrophy, – severe renal parenchymal diseas disease, and severe diffuse– intrarenal arteriolar disease.

• renal function can deteriorate after renal arteryangioplasty, especially in patients with stable renal functionprior to the intervention

Referencias

• Atherosclerotic renal artery stenosis: Current therapy and future developments Am Heart J 2009;158:154-62

• Management of Renal Artery Stenosis Progress in Cardiovascular Disease 52 (2009) 229–237

• Primary stenting for atherosclerotic renal artery stenosis J Vasc Surg 2010;51:1574-80.)

• STAR Revascularization versus Medical Therapy for Renal-Artery Stenosis N Engl J Med 2009;361:1953-62.

• RAS renal function: a randomized trial. Ann Intern Med• 2009;150:840-8.