Current status and future perspectives of renal Current status and future perspectives of renal stenting and renal denervation: stenting and renal denervation: Who is still indications for renal arteries stenting? Who is still indications for renal arteries stenting? Tadeusz Przewłocki Tadeusz Przewłocki PINC in Kraków 14 11th Peripheral Interventions Workshop 8-9 May 2014 Institute of Cardiology – Collegium Medicum, Jagiellonian University, John Paul II Hospital Kraków
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Renal stenting and denervation - prof. Tadeusz Przewłocki
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Current status and future perspectives of renal Current status and future perspectives of renal stenting and renal denervation:stenting and renal denervation:
Who is still indications for renal arteries stenting?Who is still indications for renal arteries stenting?
Tadeusz PrzewłockiTadeusz Przewłocki
PINC in Kraków 1411th Peripheral Interventions Workshop
8-9 May 2014
Institute of Cardiology – Collegium Medicum,Jagiellonian University, John Paul II Hospital
Harding et al.J Am Soc Nephrol 1992, 2, 1608Harding et al.J Am Soc Nephrol 1992, 2, 1608Olin et al.. Am J Med. 1990, 88, 46Olin et al.. Am J Med. 1990, 88, 46
General populationGeneral population0,1 – 1 %0,1 – 1 %
Papaverine – 8 – 40 mg intrarenally (Subramanian, De Bruyne)RBF mean increase 50%
Dopamine – 50ug/kg – intrarenally (De Bruyne) RBF mean increase 95%
In contrast to coronary arteries best renal dilators occureddopamine De Bruyne at al.
FFR Guided Renal Angioplasty
Mean Hyperemic GradientMean Hyperemic GradientR
esp
on
de
rs %
>20m
m H
g
<20m
m H
g0
100
Hyperemic mean gradient >20mmHg (dopamine) independent predictor of blood pressure control improvement after RAS
Blood Pressure RespondersBlood Pressure RespondersImprovement: BP < 140/90 mmHg, or a decrease of DBP by 15 mm Hg on the same or reduced # of medications.
< .80RFFR<0,80
In summary it seems we have two ways of physiological stenosis assessment:
Gradient - across the lesion – resting or hyperemic>20 mmHg(De Bruyne, Massoud, Trana),
Pd/Pa ratio - resting - <0,9 (De Bruyne)hyperemic (RFFR)<0,8 (Mitchell, De
Bruyne,),
Renal FFR of <0.80 predicts an increased Renal FFR of <0.80 predicts an increased
likelihood of BP response.likelihood of BP response.
Renal artery stenosis – criteria for interventionRenal artery stenosis – criteria for intervention
Clinical arterial hypertension(IIa)-resistant, malignant, accelerated failed 3 drugs in max dose