1545_Mathews.pdf

1、Renal Stenting in 2025:Is There a Role for Hypertension?S.Jay Mathews,MD,MS,FACC,FSCAIDirector,CCL,PERT,&Structural HeartManatee Memorial Hospital,Bradenton FLDisclosuresSpeakers Bureau:Philips Corporation Penumbra Boston Scientific CordisConsultant:Penumbra Philips Corporation Reflow Medical Cordis

2、 Abbott Shockwave Inquis Endologix Harland Medical Terumo Frostbite Medical CagentGrant/Research Support:Philips Reflow Medical Boston Scientific Abbott Penumbra Contego Innova Vascular Akura Medical R3 Gore CagentEquity:Reflow Medical Evident Vascular Protexa Akura Medical Innova VascularMedical/Sc

3、ientific Boards:Boston ScientificMedtronicPhilipsAkura MedicalEvident VascularContegoProtexaInnova VascularIntellivascCagentRenal Artery Stenosis Common in the Elderly(6.8%of Age 65)Common Etiology for Secondary HTN(0.5 to 5%of all Hypertensive Patients)Common in CAD Patients(50-70%on Necropsy)Commo

4、n in CKD(5.5-25%)Scoble et al.,where 14%of new dialysis referrals for ESRD were due to underlying RAS Transplant Vasculopathy 10%Will Progress to OcclusionExpert Rev Cardiovasc Ther.2011;9(10):1347-1360Prior Strategy“Drive by Renal”Stenting Indiscriminate Intervention with Unclear Benefits Prior Stu

5、dies with Inconclusive Results DRASTIC PTA trial with negative results STAR The primary end point was a 20%or greater decrease in creatinine clearance and this was reached in 15.6%patients who had undergone stenting and 16%of the medically treated group(hazard ratio:0.73;95%CI:0.331.61).Procedural C

6、omplications:3 Deaths,1 Dialysis Expert Rev Cardiovasc Ther.2011;9(10):1347-1360ASTRAL:Stent/Med Rx vs Med RxClinical Syndrome:Uncontrolled/Refractory HTN or Renal Dysfunction-AND-Atherosclerotic Renal Artery Stenosis:Angiographic,ORDuplex,ORMRA,ORCTA-AND-Clinician Unsure if Stenting or Medical Ther