肾动脉狭窄支架术现状演示文稿

肾动脉狭窄支架术现状演示文稿本文档共49页；当前第1页；编辑于星期二\5点56分（优选）肾动脉狭窄支架术现状本文档共49页；当前第2页；编辑于星期二\5点56分ARAS90%FMD10%

CommoncausesofrenalarterystenosisHTRenaldysfunctionAnginapectorisParoxysmalacutepulmonaryedemaPresentationofrenalarterystenosis本文档共49页；当前第3页；编辑于星期二\5点56分Haemodynamics:>50%Renalperfusionpressurereduction>70%RPP<75-85mmHg,autonomicregulationlosePathology:Glomcrulus：arteriosclerosis,mesenteriumproliferation，Nephrictubule：epithelialcellsdenudation、apoptosis,Focalnecrosis，Renalinterstitium：Inflammatorycellinfiltration、fibrocyteproliferationEndstage：renalatrophyAtheroscleroticnephrosis本文档共49页；当前第4页；编辑于星期二\5点56分NaturalcourseofARASstudyNF/U(mon)prograssion(%)Occlusion(%)Caps17033519Zierler80244811Tollefson4854539Schreiber85524416本文档共49页；当前第5页；编辑于星期二\5点56分Developtototalocclusionwithin5years15%Deteriorationgraduallywithin5years

10-20%DeveloptoESRDannually5-15%3-yearmortalityinPt.withESRDondislysis50%SurvivalofARASPt.withESRDondislysis:5-year18%10-year5%AtheroscleroticRASprogression本文档共49页；当前第6页；编辑于星期二\5点56分Conlonetal,KidneyInt2001Oct;60:490-7Renalangioin3987Pt.undergoingcath

Independentpredictorofmortality本文档共49页；当前第7页；编辑于星期二\5点56分Conlonetal,KidneyInt2001Oct;60:490-7Renalangioin3987Pt.undergoingcathIndependentpredictorofmortality本文档共49页；当前第8页；编辑于星期二\5点56分Case1:male，62y，HT本文档共49页；当前第9页；编辑于星期二\5点56分Case2:male,78y，HT,DM,Renaldysfunction本文档共49页；当前第10页；编辑于星期二\5点56分Renalfunction:improement：GFRincrese15%/Scrdecrease0.2mg/dLstable：GFRchange<15%/Scrchange<0.2mg/dLineffective：GFRdecrease>15%/Scrincrease>0.2mg/dL

benefit：ImproementorstableBloodpressure:cure：SBP<140mmHgandDBP<90mmHg,withoutanyanti-hypertensiondrugs，improement：SBP<140mmHgandDBP<90mmHg,or,DBPdecrease>15mmHgwithsimilarorlessanti-hypertensiondrugsineffective：BPchangenotmeettheabovestandardbenefit：cureandimprovementStandardforprognosisevaluationafterrenalarterystenting(Rundback)本文档共49页；当前第11页；编辑于星期二\5点56分RenalarterystentingsuccessratestudyNProceduralsuccess(%)Burket127100Rodriguez10898Rocha15097QueenMaryhospital64100RuijinHospital12899本文档共49页；当前第12页；编辑于星期二\5点56分PTRAonhepertensionstudyF/U(m)caursecure(%)Improve(%)Nochange（%)Lossino60FMDARAS571221512137Tegtmeyer39FMDARAS37256355020QMH34ARAS113257RJH6ARAS115633本文档共49页；当前第13页；编辑于星期二\5点56分PTRAonrenalfunctionstudyNtechniquestable/improve(%)deterioration（%)Rodriguez105stent7228Rocha150stent928Steinbach222stent928QMH31stent8713RJH87stent6327本文档共49页；当前第14页；编辑于星期二\5点56分Long-termeffectofstentingonRAS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）摘要：目的:评价肾动脉支架术治疗肾动脉狭窄的长期疗效。方法:连续134例显著肾动脉狭窄患者接受肾动脉支架术。记录患者术前ֻ术后24小时ֻ1年和2年长期的血清肌酐（sCr），和血压变化情况。结果:134例患者均成功置入支架，术后24小时肌酐较术前升高[（109.8±24.6）μmol/L比（99.4±27.8）μmol/L]，肾小球滤过率[（57.6±19.3）ml/min比（68.5±18.9）ml/min]较术前降低，但术后1年和2年的平均肌酐和术前比较差异无显著性。肾动脉介入治疗术后6月，64例血压得到改善。术后1年的平均血压为（148.6±22.6）mmHg，与术前比较有显著性意义。术后1年和2年分别有56例(50.9%)和50例(49.6%)患者获益。结论:肾动脉支架术治疗肾动脉狭窄的远期疗效较好，且长期随访结果满意。关键词：动脉粥样硬化；肾动脉梗阻；介入治疗本文档共49页；当前第15页；编辑于星期二\5点56分本文档共49页；当前第16页；编辑于星期二\5点56分

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本文档共49页；当前第32页；编辑于星期二\5点56分WhysomePt.gainnobenefitfromRASstenting?本文档共49页；当前第33页；编辑于星期二\5点56分RenalparenchymaimpairmentdiabeticnephropathyrenalimpairmentduetoHTrenalimpairmentduetoothersIschemicnephropathyAgeCINRestenosisfactorsInfluencingtheoutcomesinRASunderwentstent本文档共49页；当前第34页；编辑于星期二\5点56分 nephronredunctionvolume-dependenthypertension：(BilRAS/renaldysfunction)renin-dependenthypertension：(uniRAS)sympatheticnervoussystemvasoactivesubstancesecretedfromkidney：natriuretichormonevasopressinMechanismofhypertensioninCKD本文档共49页；当前第35页；编辑于星期二\5点56分RenalarteriolarsclerosisinbenignhypertensionEarlystage：hyalinizationinafferentglomerulararterioleandarteriainterlobularesadvancedstage：glomerulus,nephrictubule,renalinterstitiumdiseaserenalarteriolarsclerosisinmalignanthypertension(DBP>120mmHg)Necroticarteriolitis,ProliferatingendarteritisPathologyofhypertension-inducedrenalimpairment本文档共49页；当前第36页；编辑于星期二\5点56分NephrosisduttocholesterolcrystalembolizationEpidemiology：authorpopulationcasesincidence(%)FloryAortaAS2673.3Orossautopsy37222.4JonesUnexplainedrenaldysfunction2451.0Preston>65years3344.2etiologicalfactor：AS、endovascularprocedure本文档共49页；当前第37页；编辑于星期二\5点56分Henry(Percusurge)AJCOct,2000TCT30RASof24Pt.(27ostial)Allhadrenalimpairement,71%hadHTSuccessrate100%Occlusiontime418sec(149-797)Embolizationafterstenting本文档共49页；当前第38页；编辑于星期二\5点56分EmbolizationafterstentingImprovedrenalfunction46%Unchanged4%Acutedeterioration0%Norenalfunctiondeterioretionat6month6/30(20%)empty24/30(80%)hadfiltercontentChronicthrombusCholesterolcleftsfragment本文档共49页；当前第39页；编辑于星期二\5点56分KidneyinelderlyKidneychange

vesselofkidney：renalarteriolarsclerosis

renalglomerulus：normaladult1.3million，1/3-1/2lostin70year-old

renaltubule：epithelialcellhypertrophia,renalinterstitium：atrophy,fibrosisRenalfunctionchange

renalbloodflow：10%redunctionper10years

GFR：Among40-80year-old,GFRdecrease0.8-1ml/minevery1year

本文档共49页；当前第40页；编辑于星期二\5点56分Kidneyinelderly本文档共49页；当前第41页；编辑于星期二\5点56分Contrastinducednephrosis(CIN)AcuterenalimpairmentaftercontrastapplicationScrincrease>44.2μmol/LOr,increase>25%comparedtobaselinePrevalence:unselectedPt.:1-6%，Highrisk40-50%

本文档共49页；当前第42页；编辑于星期二\5点56分RiskfactorsrelatedtoCINExistedrenaldysfunctionDMVasculardiseaseElderlyLowerEFhypovolemiadehydrationCongestiveheartfailurenephroticsyndrome;LiverCirrhosisBergKJ,ScandJUrolNephrol2000;34:317-322本文档共49页；当前第43页；编辑于星期二\5点56分EffectofDMandrenalfunctionontheincidenceofCIN(n=1196）RI：renalimpairmentDM：diabetes

Rudnicketal.(1995)0510152025+RI+DM+RI–DM–RI+DM–RI–DM0%5.7%19.7%%0.6%本文档共49页；当前第44页；编辑于星期二\5点56分EffectofDMandrenalfunctiononCINwithdifferentcontrastapplication0102030405060*定义为血清肌酐升高＞44.2μmol/l或＞25%（Laμtinetal.应用的标准为＞26.5μmol/l或＞20%）**基线血清肌酐＞133μmol/l（Barrettetal.的研究中＞124μmol/l）Patients(%)VisipaqueOmnipaqueorthersAspelinetal.2003Manskeetal.1990Wangetal.2000Rudnicketal.1995Taliercioetal.1991Lautinetal.1991Barrettetal.1992本文档共49页；当前第45页；编辑于星期二\5点56分RenalarterystentingrestonosisauthorscasesF/Urestenosis(%)Shammas1322-20月26Wienklin403.3年12.5Zeller1564年11.4IIkay2614.3Yutan88531QueenMaryhospital641212.5RuijinHospital1086-20月11.5本文档共49页；当前第46页；编辑于星期二\5点56分2006AHA/ACC

Guideline

IndicationsforRASRevascularization(a)AsymptoaticStenosis（ClassIIb）1.asymptomaticbilateralorsolitaryviablekidneywithahemodynamicallysignificantRAS.(Levelofevidence:C)

2.asymptomaticunilateralhemodynamicallysignificantRASinaviablekidneyisnotwellestablishedandispresentlyclinicallyunproven.(Levelofevidence:C)(b)Hypertension（ClassIIa）hemodynamicallysignificantRASandacceleratedhypertension,resistanthypertension,malignanthypertension,hypertensionwithanunexplainedunilateralsmallkidney,andhypertensionwithintolerancetomedication.(Levelofevidence:B)JVascIntervRadiol.2006Sep;17(9):1383-97本文档共49页；当前第47页；编辑于星期二\5点56分

PreservationofRenalFunctionClassIIaRASandprogressivechronickidneydiseasewithbilateralRASoraRAStoa