肾血管性高血压的介入治疗-心内科观点.pptVIP

肾血管性高血压的介入治疗-心内科观点 阜外心血管病医院心内科 蒋雄京 The most common causes of RAS are atherosclerosis (80%) , aortoarteritis(15%), and fibromuscular dysplasia(5%) in China Prevalence 1. 1~3% in hypertensive population 2. 20~30% in patients with secondary hypertension Incidence of Renal Artery Stenosis at Cardiac Catheterizationin Chinese population Progressive Atherosclerosis, Renal Artery Stenosis, and Ischemic Nephropathy the clinical manifestations of ARVD Medical Therapy control of blood pressure : ACE inhibitors or Angiotensin receptor blockers ? antiplatelet therapy smoking cessation aggressive control of hyperlipidemia and DM The best medical therapy for ARVD remains unclear. Medical therapy hardly prevents renal function worsen in patients with bilateral RAS or RAS of single kidney. Chabova V, et al. ? Mayo Clin Proc 2000;75:437-444 Baboolal K Am J Kidney Dis 1998;31:971-977 肾动脉支架置入 meta-analysis data demonstrating superiority of renal artery stent compared with balloon angioplasty for procedure success and restenosis rates 肾动脉支架的临床结果 文献汇总分析： 肾功能： 1/3 提高 1/3 不变 1/3恶化 高血压： ASTRAL Angioplasty and STent for Renal Artery Lesions UK MULTI-CENTRE TRIAL INATHEROSCLEROTIC RENOVASCULAR DISEASE ASTRAL Trial: Design Primary and secondary end points in ASTRAL Baseline Characteristics ASTRAL: Treatment Revascularization Strategies: ?Stenting 93% ?PTA alone 7% ?Post-stent residual stenosis 50%: 12% ?Complications: 7% – Perforations: 4 (1%) – Cholesterol Emboli 3 (1%) – Death 30 days of stent: 2 (0.5%) ASTRAL: Primary Endpoint, 1/Cr ASTRAL: Change in Systolic BP ASTRAL Event Composite: MI, Stroke Vascular Death Hospitalization for Angina, Fluid Overload or CHF 质 疑-1 介入治疗经验和资质缺乏 ASTRAL:平均每个中心每年入选肾动脉支架术仅1例（325/58