Renal Frame Count and Renal Blush Grade. Quantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis

Ehtisham Mahmud, Thomas W R Smith, Vachaspathi Palakodeti, Owais Zaidi, Lawrence Ang, C. Robinson Mitchell, Nayab Zafar, Guilherme Bromberg-Marin, Shahin Keramati, Sotirios Tsimikas

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Abstract

Objectives: This study sought to identify angiographic parameters of favorable clinical response to renal artery stenting. Background: Stenting improves blood pressure (BP) control in patients with renal artery stenosis (RAS), but markers predicting a favorable clinical response are limited. Methods: Renal perfusion was quantified in hypertensive patients (BP ≥140/90 mm Hg) without RAS by determining renal frame count (RFC) (angiographic frames [30 frames/s] for contrast to reach distal renal parenchyma after initial renal artery opacification) and renal blush grade (RBG) (0: none, 1: minimal, 2: normal, 3: hyperemic parenchymal blush). It was hypothesized that stenting unilateral RAS in hypertensive patients would result in decreased RFC and increased RBG, which might predict BP reduction. Results: The RFC in 17 consecutive hypertensive patients without RAS (control group) (64.4 ± 14.2 years, 12 male, 22 kidneys) was 20.1 ± 5.4, whereas RBG was 2.33 ± 0.66. In 24 consecutive hypertensive patients with unilateral RAS (study group) (72.7 ± 11.3 years, 8 male), reduced RFC (26.6 ± 9.1 to 21.4 ± 6.7, p < 0.001) and increased RBG (1.63 ± 0.71 to 2.13 ± 0.85, p = 0.03) were observed after renal stenting. At 6 months, reduced BP (systolic BP 150.6 ± 15.6 mm Hg to 128.6 ± 15.5 mm Hg, p < 0.001; diastolic BP 77.2 ± 15.6 mm Hg to 68.3 ± 10.4 mm Hg, p = 0.022) without change in number of hypertensive medications was observed. Clinical responders (systolic BP reduction >15 mm Hg) had a greater decrease in RFC (7.7 ± 4.6 vs. 1.7 ± 5.1, p = 0.009) and 78.6% of patients with >4 RFC decrease were responders (p = 0.024). Conclusions: This study shows that quantitative indices of renal perfusion (RFC and RBG) are impaired in patients with RAS and improve after stenting, and that RFC reduction is associated with BP reduction.

Original languageEnglish (US)
Pages (from-to)286-292
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume1
Issue number3
DOIs
StatePublished - Jun 2008

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Renal Artery Obstruction
Kidney
Blood Pressure
Renal Artery
Perfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Renal Frame Count and Renal Blush Grade. Quantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis. / Mahmud, Ehtisham; Smith, Thomas W R; Palakodeti, Vachaspathi; Zaidi, Owais; Ang, Lawrence; Mitchell, C. Robinson; Zafar, Nayab; Bromberg-Marin, Guilherme; Keramati, Shahin; Tsimikas, Sotirios.

In: JACC: Cardiovascular Interventions, Vol. 1, No. 3, 06.2008, p. 286-292.

Research output: Contribution to journalArticle

Mahmud, Ehtisham ; Smith, Thomas W R ; Palakodeti, Vachaspathi ; Zaidi, Owais ; Ang, Lawrence ; Mitchell, C. Robinson ; Zafar, Nayab ; Bromberg-Marin, Guilherme ; Keramati, Shahin ; Tsimikas, Sotirios. / Renal Frame Count and Renal Blush Grade. Quantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis. In: JACC: Cardiovascular Interventions. 2008 ; Vol. 1, No. 3. pp. 286-292.
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abstract = "Objectives: This study sought to identify angiographic parameters of favorable clinical response to renal artery stenting. Background: Stenting improves blood pressure (BP) control in patients with renal artery stenosis (RAS), but markers predicting a favorable clinical response are limited. Methods: Renal perfusion was quantified in hypertensive patients (BP ≥140/90 mm Hg) without RAS by determining renal frame count (RFC) (angiographic frames [30 frames/s] for contrast to reach distal renal parenchyma after initial renal artery opacification) and renal blush grade (RBG) (0: none, 1: minimal, 2: normal, 3: hyperemic parenchymal blush). It was hypothesized that stenting unilateral RAS in hypertensive patients would result in decreased RFC and increased RBG, which might predict BP reduction. Results: The RFC in 17 consecutive hypertensive patients without RAS (control group) (64.4 ± 14.2 years, 12 male, 22 kidneys) was 20.1 ± 5.4, whereas RBG was 2.33 ± 0.66. In 24 consecutive hypertensive patients with unilateral RAS (study group) (72.7 ± 11.3 years, 8 male), reduced RFC (26.6 ± 9.1 to 21.4 ± 6.7, p < 0.001) and increased RBG (1.63 ± 0.71 to 2.13 ± 0.85, p = 0.03) were observed after renal stenting. At 6 months, reduced BP (systolic BP 150.6 ± 15.6 mm Hg to 128.6 ± 15.5 mm Hg, p < 0.001; diastolic BP 77.2 ± 15.6 mm Hg to 68.3 ± 10.4 mm Hg, p = 0.022) without change in number of hypertensive medications was observed. Clinical responders (systolic BP reduction >15 mm Hg) had a greater decrease in RFC (7.7 ± 4.6 vs. 1.7 ± 5.1, p = 0.009) and 78.6{\%} of patients with >4 RFC decrease were responders (p = 0.024). Conclusions: This study shows that quantitative indices of renal perfusion (RFC and RBG) are impaired in patients with RAS and improve after stenting, and that RFC reduction is associated with BP reduction.",
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T1 - Renal Frame Count and Renal Blush Grade. Quantitative Measures That Predict the Success of Renal Stenting in Hypertensive Patients With Renal Artery Stenosis

AU - Mahmud, Ehtisham

AU - Smith, Thomas W R

AU - Palakodeti, Vachaspathi

AU - Zaidi, Owais

AU - Ang, Lawrence

AU - Mitchell, C. Robinson

AU - Zafar, Nayab

AU - Bromberg-Marin, Guilherme

AU - Keramati, Shahin

AU - Tsimikas, Sotirios

PY - 2008/6

Y1 - 2008/6

N2 - Objectives: This study sought to identify angiographic parameters of favorable clinical response to renal artery stenting. Background: Stenting improves blood pressure (BP) control in patients with renal artery stenosis (RAS), but markers predicting a favorable clinical response are limited. Methods: Renal perfusion was quantified in hypertensive patients (BP ≥140/90 mm Hg) without RAS by determining renal frame count (RFC) (angiographic frames [30 frames/s] for contrast to reach distal renal parenchyma after initial renal artery opacification) and renal blush grade (RBG) (0: none, 1: minimal, 2: normal, 3: hyperemic parenchymal blush). It was hypothesized that stenting unilateral RAS in hypertensive patients would result in decreased RFC and increased RBG, which might predict BP reduction. Results: The RFC in 17 consecutive hypertensive patients without RAS (control group) (64.4 ± 14.2 years, 12 male, 22 kidneys) was 20.1 ± 5.4, whereas RBG was 2.33 ± 0.66. In 24 consecutive hypertensive patients with unilateral RAS (study group) (72.7 ± 11.3 years, 8 male), reduced RFC (26.6 ± 9.1 to 21.4 ± 6.7, p < 0.001) and increased RBG (1.63 ± 0.71 to 2.13 ± 0.85, p = 0.03) were observed after renal stenting. At 6 months, reduced BP (systolic BP 150.6 ± 15.6 mm Hg to 128.6 ± 15.5 mm Hg, p < 0.001; diastolic BP 77.2 ± 15.6 mm Hg to 68.3 ± 10.4 mm Hg, p = 0.022) without change in number of hypertensive medications was observed. Clinical responders (systolic BP reduction >15 mm Hg) had a greater decrease in RFC (7.7 ± 4.6 vs. 1.7 ± 5.1, p = 0.009) and 78.6% of patients with >4 RFC decrease were responders (p = 0.024). Conclusions: This study shows that quantitative indices of renal perfusion (RFC and RBG) are impaired in patients with RAS and improve after stenting, and that RFC reduction is associated with BP reduction.

AB - Objectives: This study sought to identify angiographic parameters of favorable clinical response to renal artery stenting. Background: Stenting improves blood pressure (BP) control in patients with renal artery stenosis (RAS), but markers predicting a favorable clinical response are limited. Methods: Renal perfusion was quantified in hypertensive patients (BP ≥140/90 mm Hg) without RAS by determining renal frame count (RFC) (angiographic frames [30 frames/s] for contrast to reach distal renal parenchyma after initial renal artery opacification) and renal blush grade (RBG) (0: none, 1: minimal, 2: normal, 3: hyperemic parenchymal blush). It was hypothesized that stenting unilateral RAS in hypertensive patients would result in decreased RFC and increased RBG, which might predict BP reduction. Results: The RFC in 17 consecutive hypertensive patients without RAS (control group) (64.4 ± 14.2 years, 12 male, 22 kidneys) was 20.1 ± 5.4, whereas RBG was 2.33 ± 0.66. In 24 consecutive hypertensive patients with unilateral RAS (study group) (72.7 ± 11.3 years, 8 male), reduced RFC (26.6 ± 9.1 to 21.4 ± 6.7, p < 0.001) and increased RBG (1.63 ± 0.71 to 2.13 ± 0.85, p = 0.03) were observed after renal stenting. At 6 months, reduced BP (systolic BP 150.6 ± 15.6 mm Hg to 128.6 ± 15.5 mm Hg, p < 0.001; diastolic BP 77.2 ± 15.6 mm Hg to 68.3 ± 10.4 mm Hg, p = 0.022) without change in number of hypertensive medications was observed. Clinical responders (systolic BP reduction >15 mm Hg) had a greater decrease in RFC (7.7 ± 4.6 vs. 1.7 ± 5.1, p = 0.009) and 78.6% of patients with >4 RFC decrease were responders (p = 0.024). Conclusions: This study shows that quantitative indices of renal perfusion (RFC and RBG) are impaired in patients with RAS and improve after stenting, and that RFC reduction is associated with BP reduction.

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