肾动脉狭窄支架术现状(ppt)

100 98 97 100
99
PTRA on hepertension
study
F/U(m) caurse
Lossino
Байду номын сангаас
60 FMD
ARAS
Tegtmeyer 39 FMD
ARAS
QMH
34 ARAS
cure(%)
57 12 37 25 11
Improve (%) 21 51 63 55 32
No change （%) 21 37 0 20 57
5-year 10-year
15% 10-20% 5-15%
50%
18% 5%
Independent predictor of mortality
Conlon et al, Kidney Int 2001 Oct;60:490-7
Renal angio in 3987 Pt. undergoing cath
Atherosclerotic nephrosis
Haemodynamics: >50% Renal perfusion pressure reduction >70% RPP<75-85mmHg, autonomic regulation lose
Pathology: Glomcrulus：arteriosclerosis, mesenterium proliferation， Nephric tubule：epithelial cells denudation、apoptosis,Focal necrosis， Renal interstitium：Inflammatory cell infiltration、fibrocyte proliferation End stage ：renal atrophy
Natural course of ARAS
study
N
Caps
170
Zierler
80
Tollefson 48
Schreiber 85
F/U(mon)
33 24 54 52
prograssion Occlusion
(%)
(%)
51
9
48
11
53
9
44
16
Atherosclerotic RAS progression
10 9
uni
100
Bilat
90
89
No RAS RAS
8
80
7
6
4.8
5
70
57
60
50
4
40
3
30
2
0.8
20
1
10
0 >75% RAS
0 4y survival
Independent predictor of mortality
Conlon et al, Kidney Int 2001 Oct;60:490-7
Case 2: male, 78y，HT, DM, Renal dysfunction
Standard for prognosis evaluation after renal artery stenting (Rundback)
Renal function:
improement： GFR increse 15% /Scr decrease 0.2mg/dL
benefit： cure and improvement
Renal artery stenting success rate
study
N
Burket
127
Rodriguez 108
Rocha
150
Queen Mary 64 hospital
Ruijin
128
Hospital
Procedural success(%)
92
8
31
stent
87
13
87
stent
63
27
Long-term effect of stenting on RAS
肾动脉支架术治疗肾动脉狭窄患者的 倪钧 张瑞岩 胡健 张宪 郑爱芳 沈卫峰 上海交通大学附属瑞金医院心脏科（200025）
hypertension drugs，
improement： SBP<140mmHg and DBP<90mmHg, or, DBPdecrease >
15mmHg
with similar or less anti-hypertension drugs
ineffective： BP change not meet the above standard
Develop to total occlusion within 5 years Deterioration gradually within 5 years Develop to ESRD annually 3-year mortality in Pt. with ESRD on dislysis Survival of ARAS Pt. with ESRD on dislysis:
肾动脉狭窄支架术现 状(ppt)
（优选）肾动脉狭窄支架术现状
Common causes of renal artery stenosis
ARAS 90% FMD 10%
Presentation of renal artery stenosis
HT Renal dysfunction Angina pectoris Paroxysmal acute pulmonary edema
stable：
GFR change<15% / Scr change <0.2mg/dL
ineffective： GFR decrease >15% / Scr increase >0.2mg/dL
benefit： Improement or stable
Blood pressure:
cure：
SBP<140mmHg and DBP<90mmHg, without any anti-
RJH
6 ARAS
11
56
33
PTRA on renal function
study
Rodriguez Rocha Steinbach QMH RJH
N
technique stable/improve deterioration
(%)
（%)
105
stent
72
28
150
stent
92
8
222
stent
Renal angio in 3987 Pt. undergoing cath
100
uni
100
50%
90 80
Bilat
90
80
70
68
75% >95％
70
59
70
60
47
60
48
50
50
40
40
30
30
20
20
10
10
0 4y survival
0 4y survival
Case 1: male，62y，HT