Technological Advances in the Design of Catheters and Devices Used in Renal Artery Interventions: Impact on Complications

Abstract

Purpose: To analyze the impact of technical improvements in stent devices and guiding catheters (e.g., reduced device diameter, increased flexibility) on the complication rates associated with percutaneous renal artery interventions. Methods: During a 5-year period (1997–2001), 268 consecutive patients (178 men; mean age 67±9 years) had 370 atherosclerotic renal artery stenoses (RAS) ≥70% treated with angioplasty/stenting in 320 procedures. The guiding catheter technique was used routinely until 2000; in 2001, a guiding sheath was used in 29% of cases. From 1997 to 2000, sealing devices were frequently used for sheath removal; during the last year, the sheaths were removed using the Femostop device. Results: In 320 interventions, 32 (10%) complications occurred, with a decreasing frequency during the last 2 years (1996/97: 13% [7/53]; 1998: 16% [9/57]; 1999: 15% [11/74]; 2000: 4% [3/70]; 2001: 3% [2/66]). There were 21 (6.6%) local complications, including 4 cases requiring permanent hemodialysis after the intervention and 11 (3.4%) access site complications. No procedure-related death occurred. During the study period, the average sheath diameter was reduced from 8.15±0.76 F to 6.15±0.63 F (p<0.05). Mean procedural time was reduced from 42±13 minutes to 23±11 minutes (p<0.05). The initial heparin dose was reduced from 10,000 to 5000 units. Conclusions: In parallel with the use of more flexible catheters and premounted stents of lower profile, the complication rate of renal angioplasty/stenting of atherosclerotic RAS has been reduced significantly during a 5-year period.