P4556Predictors of renal artery in-stent restenosis after revascularization in patients with significant atherosclerotic renal artery stenosis

Introduction:In-stent restenosis (ISR) after initial successful renal angioplasty in hypertensive patients with atherosclerotic renal artery stenosis (RAS) is a common complication, but the mechanisms remain poorly understood. Purpose:The study aimed to determine the incidence of ISR after successful renal revascularization with stent implantation in a group of patients with hemodynamically significant atherosclerotic RAS.Methods: This is a prospective study enrolling 78 consecutive patients who underwent renal artery stent placement for atherosclerotic RAS (34-unilateral, 28bilateral, 14-RAS in a solitary kidney).Clinical, biological and echocardiographic follow-up was performed in all patients at 12 months.Predefined study outcome included one-year ISR.The mean follow-up period after revascularization was 24.27±12.16months.Univariate and multivariate regression analysis were performed in order to identify ISR associated risk factors.Results: ISR was documented in 23.2% of the studied patients and treated by either stent placement or percutaneous transluminal angioplasty.No significant differences in terms of ISR have been documented among the three groups (uni-, bilateral, solitary kidney).Multivariate regression analyses (stepwise Likelihood ratio) confirmed 4 parameters as independent predictors for ISR: smoking, anti-platelet therapy, statins and severe anemia after renal revascularization.The emerged multi-parametric model emphasized a 90.7% accuracy in predicting ISR in the angiographic controlled population with renal artery stenosis.Conclusions: The present findings underlined the benefit of both statins and antiplatelet therapy after renal stenting, providing vascular anti-remodeling, pleiotropic effects and plaque stabilization.