肾血管性高血压导致一过性肺水肿临床病例报告及治疗

目的探讨肾动脉狭窄导致肾血管性高血压引起的一过性肺水肿的原因和治疗措施。方法本文报告了3例肾动脉狭窄引起的一过性肺水肿患者,观察疾病的临床特点,采用肾动脉介入治疗肾动脉狭窄导致肾血管性高血压引起的一过性肺水肿。结果肾动脉狭窄导致的肾血管性高血压是引起的一过性肺水肿的原因。3例肾动脉狭窄引起的一过性肺水肿患者中,2例是大动脉炎引起的肾动脉狭窄,1例是动脉粥样硬化引起的肾动脉狭窄。在这3例肾动脉狭窄患者中,有2例是双侧肾动脉狭窄,有1例是单侧肾动脉狭窄。这3例患者反复发生一过性肺水肿。介入治疗后,随访1年未再出现一过性肺水肿。结论介入治疗是肾血管性高血压导致一过性肺水肿的有效治疗措施之一。     

小直径肾动脉狭窄应用西罗莫司洗脱支架的安全性和有效性

目的评估小直径肾动脉粥样硬化性狭窄患者应用冠状动脉西罗莫司洗脱支架的安全性和有效性。方法两年内入选15例患者,平均年龄67·7岁。双侧肾动脉狭窄或闭塞和单侧肾动脉狭窄各6例,副肾动脉狭窄3例。应用2种国产西罗莫司洗脱(火鸟和同心)冠状动脉支架。研究主要终点包括术后1、3和6个月靶病变直径狭窄程度(再狭窄率)和肾功能状态。结果在15例患者19处病变共成功置入22个支架,其中西罗莫司洗脱支架19个,肾动脉金属裸支架3个。全部患者完成了1个月肾动脉Doppler超声随访和血清肌酐随访,其中5例和7例分别完成了3个月和6个月的前述随访,还有3例进行了6个月血管造影随访。随访结果均未显示靶血管再狭窄,并且肾功能较术前没有明显变化。结论冠状动脉西罗莫司洗脱支架可以安全和有效应用于治疗小直径肾动脉粥样硬化性狭窄患者。     

Improved hemodynamic, angiographic and functional results after renal artery stenting

Eighteen patients with severe renal artery atherosclerosis underwent conventional percutaneous transluminal renal angioplasty (PTRA) followed immediately by implantation of an endovascular stent. Hemodynamic measurements showed a baseline trans-stenotic pressure gradient of 78.3 mmHg that was reduced to 14.8 mmHg after PTRA. The post PTRA trans-stenotic pressure gradient was further reduced to 0.86 mmHg after stent placement. The average baseline diameter stenosis of 81.3% was reduced to 43.7% after PTRA and 6.1% after stent placement. Six month angiographic follow-up revealed restenosis in 6/16 patients. In patients treated for chronic renal insufficiency without restenosis the 6 month creatinine was 1.46 mg/dl compared to a pre-procedure creatinine of 2.4 mg/dl. Therefore those patients with renal insufficiency and renal artery stenosis who had long term patency after successful stent implantation showed significant improvement in renal function at six months. Stent implantation also significantly improved acute hemodynamic results and acute angiographic results compared to conventional renal artery angioplasty.     

Renal artery stenosis

Among the indications for renal artery revascularization, either surgical or endovascular, in patients with renal artery stenosis are poorly controlled hypertension, ischemic nephropathy (preservation of renal function), or recurrent episodes of "flash" pulmonary edema and congestive heart failure. Pharmacologic treatment is the first-line therapy to control blood pressure. If the disease is unilateral, the blood pressure regimen should include an angiotensin-converting enzyme inhibitor. Guidelines published in the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of high blood pressure should be followed. Revascularization is recommended if patients have at least 75% stenosis of one or both renal arteries, combined with resistant or poorly controlled hypertension; recurrent flash pulmonary edema; dialysis-dependent renal failure resulting from renal artery stenosis; chronic renal insufficiency and bilateral renal artery stenosis; or renal artery stenosis to a solitary functioning kidney. To treat fibromuscular disease of the renal arteries, percutaneous transluminal angioplasty is the revascularization procedure of choice. Ex vivo surgical repair of the renal artery may be required if there is significant branch renal artery stenosis. To treat atherosclerotic renal artery stenosis, the revascularization procedure of choice is percutaneous transluminal angioplasty and stent implantation, especially if there is concomitant ostial or proximal renal artery disease. Surgical revascularization is performed if concomitant aortic surgery is required, such as for abdominal aortic aneurysm.     

冠状动脉支架放置术治疗肝移植术后肝动脉狭窄

目的评价肝移植术后肝动脉狭窄时冠状动脉支架应用的可行性和有效性。方法2003年11月至2005年9月,14例肝移植术后肝动脉狭窄患者接受肝动脉冠状动脉支架放置术治疗,其中早期治疗10例,延迟治疗4例。总结肝动脉冠状动脉支架放置术的技术结果、肝动脉通畅及患者临床转归等情况。结果冠状动脉支架放置术成功率达100％。中位随诊146d(9～345 d),2例患者分别于术后26 d和45 d出现再狭窄,其余患者肝动脉均保持通畅；10例早期介入治疗的患者中,2例分别于术后9 d和30 d死于败血症性多器官功能衰竭,1例患者由于反复胆道感染于术后147 d接受再次肝移植,其余患者术后肝功能指标正常且无症状生存。4例延迟治疗的患者中,1例生存至今已345 d,但肝功能反复出现异常,其余3例死于肝脓肿和胆道感染导致的多器官功能衰竭。结论肝动脉冠状动脉支架放置术可以成功治疗肝移植术后肝动脉狭窄,早期介入治疗是取得良好的临床疗效的关键。     

Diabetes mellitus does not preclude stabilization or improvement of renal function after stent revascularization in patients with kidney insufficiency and renal artery stenosis.

OBJECTIVE: To assess the impact of stent revascularization on the renal function of diabetic and nondiabetic patients with renal insufficiency. BACKGROUND: Renal artery revascularization has been shown to stabilize or improve renal function in patients with significant renal artery stenosis and impaired renal function. However, some studies have suggested negligible or no benefit of renal function in diabetic patients with the same condition. METHODS: We retrospectively compared data from 50 consecutive patients undergoing renal artery stent placement with renal insufficiency (serum creatinine > or = 1.5-4.0 mg/dl) and global ischemia (bilateral or solitary [single] kidney renal artery stenosis) There were 17 diabetic (DM) and 33 nondiabetic (NDM) patients. The endpoints included the follow-up measurements of renal function, blood pressure, and number of antihypertensive medications. RESULTS: After stent placement, at a mean follow-up of 42 +/- 18 months (range: 6-62 months), 79% NDM (N = 26), and 76% DM patients (N = 13) (P = NS) had improvement in the slope of the reciprocal of creatinine (1/SCr), indicating a beneficial effect in renal function in many patients. CONCLUSION: Renal artery stent placement appears to be equally beneficial in preserving renal function in DM and NDM patients with ischemic nephropathy and global renal ischemia.     

分肾功能测量评估单侧粥样硬化性肾动脉狭窄支架术对肾功能的影响

目的 应用肾动态显像评估单侧动脉硬化性肾动脉狭窄患者腔内治疗效果,并对可能改善分肾功能的影响因素进行分析.方法 回顾性分析北京安贞医院2016年1月-2018年4月收治的60例单侧动脉硬化性肾动脉狭窄患者,均行肾动脉支架成形术.收集患者的一般资料,术前及术后肾功能检查结果,肾动脉彩色多普勒超声(彩超)及肾动态显像结果,...     

Prevalence of renal artery stenosis requiring revascularization in patients initially referred for coronary angiography.

To evaluate the prevalence of clinically significant renal artery stenosis (RAS) in patients referred for coronary angiography, we analyzed data on 2,439 consecutive patients. Patients underwent selective renal angiography in conjunction with coronary angiography if refractory hypertension (blood pressure > 140/90 on two drugs) or flash pulmonary edema was present. A total of 1,089 renal arteries of 534 patients were evaluated. Twelve percent (137/1,089) of the renal arteries in 19% (101/534) of patients had > 70% diameter stenosis in at least one vessel. Bilateral renal artery stenosis was present in 26% (26/101) of patients. One hundred and thirty-two of the 137 vessels underwent stent revascularization due to clinical renovascular hypertension. Acute clinical success (< 20% diameter stenosis without death or urgent surgery) was 98% (99/101). Due to high prevalence and effective available treatment, we recommend routine screening for RAS in all patients with refractory hypertension referred for coronary angiography.     

Peripheral vascular disease: carotid and vertebral brachytherapy for in-stent restenosis.

For years, intra-arterial brachytherapy has been a recognized method for treating recurrent stenosis after percutaneous transluminal angioplasty and stent placement. However, its use in arteries supplying the brain has not been described to date. We report a case treated with intra-arterial brachytherapy for high-grade recurrent stenoses of the high cervical internal carotid artery and the proximal vertebral artery. At 2-year follow-up, the outcome was successful.     

Predicting blood pressure improvement in hypertensive patients after renal artery stent placement: renal fractional flow reserve.

BACKGROUND: Renal stent placement improves or cures hypertension in only 60-70% of patients with renal artery stenosis (RAS) and uncontrolled hypertension. There is a need to better identify patients who are likely to respond to percutaneous renal revascularization. We investigated whether an abnormal renal fractional flow reserve (FFR) would predict blood pressure improvement in patients undergoing renal artery stent placement. METHODS: We prospectively enrolled 17 patients with unilateral RAS and medically refractory hypertension (BP > 140/90 mm Hg). Renal FFR was measured at maximal hyperemia induced by papaverine followed by renal stent placement. Blood pressure improvement was defined as a blood pressure of 相似文献   

Factors influencing the need for target vessel revascularization after renal artery stenting.

PURPOSE: To provide additional insight into factors that may be associated with the need for target vessel revascularization (TVR) following de novo renal artery stenting during long-term follow-up. METHODS: A retrospective chart and database review was conducted to analyze the progress of all patients with de novo symptomatic renal artery stenosis who underwent stent-supported angioplasty under the auspices of the Single Operator, Single Center, Renal Stent Retrospective Study (SOCRATES). The records review identified 782 patients who were enrolled in the study between 1993 and 2004; after excluding 34 (4.5%) patients (lost to follow-up or inadequate data), 748 consecutive patients (412 women; mean age 70.7+/-9.7 years, range 37-92) were suitable for longitudinal analysis. The need for TVR was based on strict clinical criteria (> or =20% rise in serum creatinine, worsening hypertension, and/or recurrent flash pulmonary edema), and all patients underwent multidisciplinary evaluation before stenting and during follow-up. RESULTS: Follow-up spanned a mean 45.8+/-26.5 months. TVR was needed in 88 (10.03%) of 877 arteries and was best predicted by patient age < or =67 years (OR 2.91, p=0.0001), stent diameter < or =5.0 mm (OR 2.31, p=0.001), solitary functioning kidney (OR 2.01, p=0.048), history of lower extremity peripheral artery disease (OR 1.87, p=0.008), and antecedent history of stroke (OR 1.73, p=0.026). CONCLUSION: Renal artery stenting appears to be durable, with only 10% of stented arteries requiring TVR during clinically-based long-term follow-up. Arteries with a final stent diameter < or =5.0 mm were more than twice as likely to need TVR, as were patients with a solitary kidney. The authors acknowledge that clinical recurrence is not a surrogate for ultrasound surveillance after renal artery stenting, so prospective controlled trials will be needed to determine risk factors for restenosis.     

Incidence of renal infarctions after transrenal stent placement in an animal model.

PURPOSE: To evaluate the incidence and appearance of renal infarctions after transrenal stent placement in an animal model. METHODS: An aortic stent was placed via a femoral approach in 20 female Merino sheep. Ten animals had intentional coverage of one renal ostium with the bare struts, 1 sheep had both renal artery ostia covered, and the other 9 sheep had no stent impingement on the renal orifices. Animals were sacrificed after 3 to 12 months (mean 6) for gross pathological and histological evaluation. Infarction locations and patterns were evaluated and correlated to stent placement. RESULTS: Of the 40 renal arteries, coverage was proven at autopsy in 12 cases; the remaining 28 arteries were free of any stent overlay. Overall, 14 (35%) renal infarctions were detected; 7 were found in the 12 arteries with a transrenal stent (58.3% incidence in covered renal arteries). By comparison, the other 7 infarctions were found in the 28 unaffected arteries (25% incidence in noncovered renal arteries; p = 0.04). All infarctions appeared to be well-defined punctate lesions. CONCLUSIONS: A transrenal stent position in the abdominal aorta is related to increased renal infarctions in an animal model.     

Restenosis after placement of Palmaz-Schatz stents in native coronary arteries. Initial results of a multicenter experience.

BACKGROUND. Several metallic intracoronary stents are currently undergoing preliminary evaluation to ascertain potential benefit as means to reduce the 30-40% incidence of restenosis after balloon angioplasty. METHODS AND RESULTS. To determine the incidence and correlates of restenosis after placement of Palmaz-Schatz stents in native coronary arteries in the first group of patients selected for this procedure, clinical and quantitative angiographic data from 206 consecutive patients (221 stenoses) with successful stent placement (diameter stenosis < 50%) were analyzed. Six patients (2.9%) had thrombosis-mediated stent closure within 1 month after stent placement and were excluded from long-term angiographic follow-up. One hundred eighty-one (91%) of the remaining 200 patients had angiography at 5.8 +/- 2.1 months. Patients with and without follow-up did not differ in any baseline characteristic; in particular, history of restenosis at the site stented (73% versus 65%), placement of multiple overlapping stents (17% versus 20%), and mean poststent diameter stenosis (16 +/- 12% versus 14 +/- 12%). The overall incidence of restenosis (diameter stenosis > or = 50% at follow-up) in this group at high risk for restenosis was 36% (95% confidence interval, 29-43%) on a per-stenosis basis. The incidence of restenosis when a single stent was placed was 30% (95% confidence interval, 23-37%). Risk was dependent upon a history of restenosis (present versus absent 36% versus 16%, p = 0.02) and upon whether or not a poststent stenosis < or = 0% was achieved (6% versus 33%, p = 0.02). When multiple overlapping stents were placed, restenosis occurred at 64% of sites, and placement of multiple stents was discouraged during the later phases of this study as these results became apparent. CONCLUSIONS. Although multiple stents appear to yield a poor long-term result, placement of single stents may offer a benefit compared with standard coronary angioplasty, particularly if an excellent angiographic result can be obtained in patients without prior restenosis. Further randomized trials in such patients are needed.     

Primary renal artery stenting: characteristics and outcomes after 363 procedures

BACKGROUND: Stenting improves the acute results of percutaneous balloon angioplasty for atherosclerotic renal artery stenosis. Predictors of benefit and angiographic restenosis are not well understood. We describe the technical and clinical success of renal artery stenting in a large consecutive series of patients with hypertension or renal insufficiency. We identify clinical, procedural, and anatomic factors that might influence outcome, restenosis, and survival. METHODS: Primary renal artery stenting was performed in 300 consecutive patients who underwent 363 stent procedures in 358 arteries. Angiograms were analyzed quantitatively. Clinical and angiographic follow-up data are available after a median of 16.0 months. RESULTS: At baseline, 87% of patients had hypertension, and 37% had chronic renal insufficiency. The mean age was 70 years (interquartile range 63.1-74.6) years. The stenosis was unilateral in 49% and bilateral in 48% and involved a solitary functioning kidney in 3.6%. The stenting procedure was successful in all attempts. There were no procedural deaths or emergency renal surgical procedures. Postprocedure azotemia was seen in 45 of 363 (12%) procedures but persisted in only 6 patients (2%), all of whom had baseline renal insufficiency. Systolic and diastolic blood pressures were significantly reduced (systolic blood pressure from 164.0 +/- 28.7 to 142.4 +/- 19.1 mm Hg, P <.001). At follow-up, 70% of patients had improved blood pressure control regardless of renal function. In patients with baseline renal insufficiency, 19% had improvement in serum creatinine levels at follow-up, 54% had stabilization, and 27% had deterioration. Follow-up mortality was 10% and was predicted by baseline creatinine levels (odds ratio 1.72 for each 1 mg/dL creatinine increment, 95% confidence interval 1.13-2.49) and extent of coronary artery disease (odds ratio 1.66 for each diseased coronary artery, 95% confidence interval 1.03-2.67). Angiographic restenosis was found in 21% of 102 patients overall and was less common (12%) in arteries with a reference caliber >4.5 mm (P <.01 vs caliber <4.5 mm). Neither poststenotic dilation nor severity of angiographic stenosis predicted clinical outcome. CONCLUSIONS: Primary renal artery stenting can be performed safely with nearly uniform technical success. The majority of patients with hypertension or renal insufficiency derive benefit. Follow-up mortality is 5-fold higher in patients with baseline renal insufficiency. Clinical and angiographic features did not predict blood pressure or renal functional outcome. Restenosis is more common in renal arteries with a reference caliber less than 4.5 mm.     

Atherosclerotic occlusive extracranial vertebral artery disease: indications for intervention, endovascular techniques, short-term and long-term results

BACKGROUND: Atherosclerotic occlusive disease of the vertebral artery (VA) affects a significant proportion of patients with cerebrovascular disease and can cause significant morbidity and mortality despite maximal medical therapy. Careful selection of both symptomatic and asymptomatic patients for intervention based on neurological symptoms, as well as anatomical and hemodynamic considerations, is essential. METHODS: To achieve proper results with angioplasty and stenting, standard endovascular techniques are modified for the unique anatomical considerations of the VA. Several technical nuances are described here to aid in the endoluminal revascularization of the VA. RESULTS: Technical success (<50% residual diameter stenosis) rates ranging from 94 to 98% and low rates of periprocedural complications have been achieved with VA angioplasty and stenting in select series with angiographic follow-up. The long-term success in those series is limited by the high (10-43%) rate of recurrent stenosis. Proper placement of the stent can reduce the risk of periprocedural complications and restenosis. In-stent stenosis appears most commonly during the first 6-12 months after stent placement, but does not appear to correlate with return of neurological symptoms. We believe the high rate of recurrent stenosis makes follow-up angiography essential, especially in the first 12 months after the procedure. CONCLUSION: Endovascular VA angioplasty with stent placement provides an innovative approach to treat a difficult clinical entity. Evolving therapies, including drug-eluting stents or bioresorbable stents, may prove to provide better long-term results.     

The natural history of incidental renal artery stenosis in patients with aortoiliac vascular disease

PURPOSE: To examine the association between incidentally discovered renal artery stenosis and deterioration of renal function as determined by the change in serum creatinine concentration over time. SUBJECTS AND METHODS: We performed a retrospective review of consecutive patients who underwent aortography for aortoiliac vascular disease. Angiograms were reviewed for renal artery stenosis, defined as a narrowing of at least 20% compared with adjacent normal renal artery. For patients with at least 180 days of subsequent follow-up, the change in serum creatinine concentration per year was compared in patients who had or did not have renal artery stenosis. RESULTS: Of the 201 patients, 96 (48%) had some degree of renal artery stenosis in one or both renal arteries, including 53 (26%) who had at least one stenosis > or= 50% and 40 (20%) who had bilateral stenoses. The only clinical predictor of renal artery stenosis was a history of coronary artery disease (odds ratio = 2.0, 95% confidence interval: 1.2 to 3.8, P = 0.001). Among the 174 patients with > or =180 days of follow-up, there was no statistically significant difference (P = 0.88) in the mean change in serum creatinine concentration per year in the 78 patients with renal artery stenosis (0.06+/-0.33 mg/dL per year) as compared with the 96 patients without renal artery stenosis (0.06+/-0.22 mg/dL per year). Grouping the patients by the maximal percentage of stenosis did not reveal any difference in the mean changes in serum creatinine concentration per year. CONCLUSIONS: Although renal artery stenosis is a common incidental finding in patients with atherosclerotic vascular disease, it is an uncommon cause of progressive renal disease.     

冠状动脉造影患者中高血压合并肾动脉狭窄发生率及其影响因素

目的:在冠状动脉造影人群中观察高血压合并肾动脉狭窄(RAS)的发生率,并分析高血压合并RAS的影响因素。方法:高血压合并胸痛进行冠状动脉造影检查的患者157例,其中男性81例(51.5%),女性76例(48.5%),收缩压(151.5±17.4)mmHg(1mmHg=0.133kPa)舒张压(94.7±10.3)mmHg,在冠状动脉造影结束后,进行选择或非选择性肾动脉造影。分别以年龄、性别、收缩压、舒张压、高脂血症、糖尿病、吸烟和冠状动脉病变严重程度为自变量,以RAS为因变量进行单因素和多变量Logistic回归分析RAS与危险因素之间的关系。结果:入选157例,其中126例(80.2%)肾动脉造影正常,另31例(19.6%)存在RAS(腔径狭窄≥30%),其中14例(8.9%)存在显著的RAS(腔径狭窄≥50%),17例(10.8%)存在轻度狭窄(30%≤直径狭窄<50%),6例(3.8%)存在显著单侧RAS(腔径狭窄≥70%),2例(1.2%)存在显著双侧RAS(腔径狭窄≥70%)。冠状动脉造影结果,确诊冠心病79例,非冠心病78例,冠心病患者中单支血管病变29例,双支病变25例,三支病变21例,左主干合并三支病变4例。单因素分析显示年龄、收缩压、糖尿病和冠状动脉病变严重程度与RAS有关;而多因素回归分析,独立预测因子为年龄(OR=1.17,95%可信区间:1.05～1.38,P<0.01)和冠状动脉病变的严重程度(OR=1.46,95%可信区间:1.03～2.04,P<0.01)。结论:接受冠状动脉造影检查的患者,高血压合并RAS的发生率高。因此,有高血压患者接受冠状动脉造影术时应考虑行肾动脉造影术。     

Angioplasty and stent treatment of transplant renal artery stenosis

Transplant renal artery stenosis is a major complication that requires a therapeutic approach involving surgery or angioplasty. The aim of this study was to analyse the evolution of renal transplant patients with renal allograft artery stenosis treated by angioplasty and stent placement. Thirteen patients were diagnosed with transplant renal artery stenosis. Clinical suspicion was based on deterioration of renal function and/or poorly controlled hypertension with compatible Doppler ultrasound findings. The diagnosis was confirmed by arteriography, performing an angioplasty with stent placement during the same operation. A progressive improvement in renal function was observed during the first 3 months after the angioplasty, and renal function then remained stable over 2 years. In addition, blood pressure improved during the first 2 years, and as a consequence there was no need to increase the average number of anti-hypertensive drugs administered (2.5 drugs per patient). In conclusion, angioplasty with stent placement is a safe and effective procedure for the treatment of transplant renal artery stenosis.     

Novel stent system for accurate placement in aorto-ostial renal artery disease: preclinical study in porcine renal artery model

BACKGROUND: Treatment of aorto-ostial renal artery stenosis has been associated with a lower procedural success and higher complication and restenosis rate, as compared to nonostial lesions. The design and delivery of currently available stent systems in ostial lesions can result in inaccurate stent positioning and placement leading to stent protrusion into the parent vessel lumen or geographic miss. A novel stent system (SquareOne Inc., Campbell, CA, USA) has been designed specifically for aorto-ostial lesions in the renal artery. This stent system aims to provide both tactile and visual confirmation of the ostium at the aorta, allow for improved accuracy during stent positioning and placement, provide complete scaffolding of the lesion at the aortic junction to the native vessel, and enable future vessel reaccess. METHODS: Stents (n=12) were implanted in both renal arteries of six swine. For histology, two animals were euthanized immediately after stent implantation, and each two animals were then followed up at 2 and 4 weeks, respectively. Intravascular ultrasound (IVUS) studies were performed immediately after stent implantation and at follow-up. RESULTS: Proper stent positioning and implantation was obtained in all animals. Angiographic and IVUS assessments indicated no dissection or thrombus formation. Histology demonstrated good apposition and endothelialization of the stent strut surface. CONCLUSION: The unique flared shape of this novel ostial stent system allows for improved accuracy during stent positioning and placement, as well as complete apposition and coverage/scaffolding of the similarly-shaped luminal ostium. Future studies will determine if this novel stent system fulfills the unmet clinical need in aorto-ostial stenoses.     

Percutaneous transluminal angioplasty in atheromatous stenosis of the renal artery. Late results

The purpose of the study was to analyse the effects on stenosis and blood pressure of percutaneous transluminal renal angioplasty in renovascular hypertension due to atheroma. Angioplasty was successfully performed in ten hypertensive patients (seven men and three women) with unilateral (seven patients) or bilateral (three patients) renal artery stenoses: dilation without complication, anatomic technical success in each case, and reduction in mean pick systolic-pressure across the stenosis. Recurrent stenoses were demonstrated in three men during the first year. After three years (mean follow-up), six patients were improved (normotensive under treatment), but all patients received an antihypertensive drug. Four failures were observed, due to recurrent stenosis in three cases. In patients with unilateral, non ostial and non completely occluded stenosis, improvement due to successful angioplasty was generally observed, incidence of recurrent stenosis was about 20 per cent. In contrast, neither cure nor improvement can be expected in patients with advanced bilateral atheromatous renal artery stenoses. A randomised trail appears necessary to demonstrate the potential improvement of renal function after angioplasty. Our results suggest that percutaneous transluminal renal angioplasty is effective for long-term control of renovascular hypertension (75 per cent) in patients with unilateral, non ostial, atheromatous artery stenosis.