Angiographic and intravascular ultrasound assessment of immediate and 9-month efficacy of percutaneous transluminal renal artery balloon angioplasty with subsequent brachytherapy in patients with renovascular hypertension

Background/Aim: Scarce data exist concerning the long-term effect of renal balloon angioplasty (PTRA) enhanced by intravascular γ-brachytherapy (IVBT) in patients with renovascular hypertension. The aim of this randomized study was to evaluate long-term outcome after PTRA with IVBT in patients with renal artery stenosis. Patients and Methods: 71 patients with renovascular hypertension were randomized into group I (PTRA + IVBT) or group II (PTRA). 9 patients who required stent implantation were excluded. Both baseline and 9-month follow-up quantitative computerized angiography and intravascular ultrasound (IVUS) analysis were performed to assess restenosis. During the 9-month follow-up, 3 patients died – 2 from group I and 1 from group II. Results: The restenosis rate was 16.1% in group I and 32.1% in group II. The 9-month lumen loss in angiography was 1.2 ± 0.7 and 1.7 ± 0.7 mm (p = 0.004) and the area loss (IVUS) was 6.5 ± 4.8 and 10.1 ± 5.6 mm2 in groups I and II, respectively (p = 0.01). eGFR increased both in group I (from 75 ± 22 to 84 ± 31 ml/min/1.73 m2; p < 0.001) and in group II (from 74 ± 23 to 77 ± 23 ml/min/1.73 m2; p = 0.04). Only the diastolic blood pressure in group I decreased significantly (65 ± 17 and 77 ± 18 mm Hg; p = 0.048). The rate of blood pressure normalization was low in both groups (6.1 and 6.9%). Conclusions: IVBT after PTRA with a self-centering source is a safe and effective method for prevention of restenosis in patients with renovascular hypertension.