Introduction: In-stent restenosis (ISR) after initial successful renal revascularization in patients with sig-nificant atherosclerotic renal artery stenosis (RAS) is a common complication, but the mechanisms remain poorly understood.
Objective: To determine the incidence of ISR after suc-cessful renal angioplasty with stent implantation in a population of hypertensive patients with hemodynami-cally significant atherosclerotic RAS.
Methods: 78 consecutive patients who underwent renal artery stent placement for atherosclerotic RAS (34-unilateral, 28-bilateral, 16-RAS in a solitary kid-ney) were enrolled. Clinical, biological and echocardi-ographic follow-up were performed in all patients at 12 months. Predefined study outcome included one-year ISR. The mean extended follow-up period after revas-cularization was 24.27±12.16 months. Univariate and multivariate regression analysis were performed in or-der to identify ISR associated risk factors.
Results: ISR was documented in 23.2% of the studied patients and treated by either stent placement or percu-taneous transluminal angioplasty. No significant diffe-rences in terms of ISR have been documented among the three groups (uni-, bilateral, solitary kidney). Mul-tivariate 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 mul-ti-parametric model emphasized a 90.7% accuracy in predicting ISR in the angiographic controlled populati-on with renal artery stenosis.
Conclusions: The present findings underlined the be-nefit of both statins and antiplatelet therapy after renal stenting, providing vascular anti-remodeling, pleiotro-pic effects and plaque stabilization.