腎動脈狹窄支架術現(xiàn)狀演示文稿

腎動脈狹窄支架術現(xiàn)狀演示文稿目前一頁\總數(shù)四十九頁\編于二十二點（優(yōu)選）腎動脈狹窄支架術現(xiàn)狀目前二頁\總數(shù)四十九頁\編于二十二點ARAS90%FMD10%

CommoncausesofrenalarterystenosisHTRenaldysfunctionAnginapectorisParoxysmalacutepulmonaryedemaPresentationofrenalarterystenosis目前三頁\總數(shù)四十九頁\編于二十二點Haemodynamics:>50%Renalperfusionpressurereduction>70%RPP<75-85mmHg,autonomicregulationlosePathology:Glomcrulus：arteriosclerosis,mesenteriumproliferation，Nephrictubule：epithelialcellsdenudation、apoptosis,Focalnecrosis，Renalinterstitium：Inflammatorycellinfiltration、fibrocyteproliferationEndstage：renalatrophyAtheroscleroticnephrosis目前四頁\總數(shù)四十九頁\編于二十二點NaturalcourseofARASstudyNF/U(mon)prograssion(%)Occlusion(%)Caps17033519Zierler80244811Tollefson4854539Schreiber85524416目前五頁\總數(shù)四十九頁\編于二十二點Developtototalocclusionwithin5years15%Deteriorationgraduallywithin5years

10-20%DeveloptoESRDannually5-15%3-yearmortalityinPt.withESRDondislysis50%SurvivalofARASPt.withESRDondislysis:5-year18%10-year5%AtheroscleroticRASprogression目前六頁\總數(shù)四十九頁\編于二十二點Conlonetal,KidneyInt2001Oct;60:490-7Renalangioin3987Pt.undergoingcath

Independentpredictorofmortality目前七頁\總數(shù)四十九頁\編于二十二點Conlonetal,KidneyInt2001Oct;60:490-7Renalangioin3987Pt.undergoingcathIndependentpredictorofmortality目前八頁\總數(shù)四十九頁\編于二十二點Case1:male，62y，HT目前九頁\總數(shù)四十九頁\編于二十二點Case2:male,78y，HT,DM,Renaldysfunction目前十頁\總數(shù)四十九頁\編于二十二點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)目前十一頁\總數(shù)四十九頁\編于二十二點RenalarterystentingsuccessratestudyNProceduralsuccess(%)Burket127100Rodriguez10898Rocha15097QueenMaryhospital64100RuijinHospital12899目前十二頁\總數(shù)四十九頁\編于二十二點PTRAonhepertensionstudyF/U(m)caursecure(%)Improve(%)Nochange（%)Lossino60FMDARAS571221512137Tegtmeyer39FMDARAS37256355020QMH34ARAS113257RJH6ARAS115633目前十三頁\總數(shù)四十九頁\編于二十二點PTRAonrenalfunctionstudyNtechniquestable/improve(%)deterioration（%)Rodriguez105stent7228Rocha150stent928Steinbach222stent928QMH31stent8713RJH87stent6327目前十四頁\總數(shù)四十九頁\編于二十二點Long-termeffectofstentingonRAS腎動脈支架術治療腎動脈狹窄患者的倪鈞張瑞巖胡健張憲鄭愛芳沈衛(wèi)峰上海交通大學附屬瑞金醫(yī)院心臟科（200025）摘要：目的:評價腎動脈支架術治療腎動脈狹窄的長期療效。方法:連續(xù)134例顯著腎動脈狹窄患者接受腎動脈支架術。記錄患者術前?術后24小時?1年和2年長期的血清肌酐（sCr），和血壓變化情況。結果:134例患者均成功置入支架，術后24小時肌酐較術前升高[（109.8±24.6）μmol/L比（99.4±27.8）μmol/L]，腎小球濾過率[（57.6±19.3）ml/min比（68.5±18.9）ml/min]較術前降低，但術后1年和2年的平均肌酐和術前比較差異無顯著性。腎動脈介入治療術后6月，64例血壓得到改善。術后1年的平均血壓為（148.6±22.6）mmHg，與術前比較有顯著性意義。術后1年和2年分別有56例(50.9%)和50例(49.6%)患者獲益。結論:腎動脈支架術治療腎動脈狹窄的遠期療效較好，且長期隨訪結果滿意。關鍵詞：動脈粥樣硬化；腎動脈梗阻；介入治療目前十五頁\總數(shù)四十九頁\編于二十二點目前十六頁\總數(shù)四十九頁\編于二十二點

目前十七頁\總數(shù)四十九頁\編于二十二點

目前十八頁\總數(shù)四十九頁\編于二十二點

目前十九頁\總數(shù)四十九頁\編于二十二點

目前二十頁\總數(shù)四十九頁\編于二十二點

目前二十一頁\總數(shù)四十九頁\編于二十二點

目前二十二頁\總數(shù)四十九頁\編于二十二點

目前二十三頁\總數(shù)四十九頁\編于二十二點

目前二十四頁\總數(shù)四十九頁\編于二十二點

目前二十五頁\總數(shù)四十九頁\編于二十二點

目前二十六頁\總數(shù)四十九頁\編于二十二點

目前二十七頁\總數(shù)四十九頁\編于二十二點

目前二十八頁\總數(shù)四十九頁\編于二十二點

目前二十九頁\總數(shù)四十九頁\編于二十二點

目前三十頁\總數(shù)四十九頁\編于二十二點

目前三十一頁\總數(shù)四十九頁\編于二十二點

目前三十二頁\總數(shù)四十九頁\編于二十二點WhysomePt.gainnobenefitfromRASstenting?目前三十三頁\總數(shù)四十九頁\編于二十二點RenalparenchymaimpairmentdiabeticnephropathyrenalimpairmentduetoHTrenalimpairmentduetoothersIschemicnephropathyAgeCINRestenosisfactorsInfluencingtheoutcomesinRASunderwentstent目前三十四頁\總數(shù)四十九頁\編于二十二點 nephronredunctionvolume-dependenthypertension：(BilRAS/renaldysfunction)renin-dependenthypertension：(uniRAS)sympatheticnervoussystemvasoactivesubstancesecretedfromkidney：natriuretichormonevasopressinMechanismofhypertensioninCKD目前三十五頁\總數(shù)四十九頁\編于二十二點RenalarteriolarsclerosisinbenignhypertensionEarlystage：hyalinizationinafferentglomerulararterioleandarteriainterlobularesadvancedstage：glomerulus,nephrictubule,renalinterstitiumdiseaserenalarteriolarsclerosisinmalignanthypertension(DBP>120mmHg)Necroticarteriolitis,ProliferatingendarteritisPathologyofhypertension-inducedrenalimpairment目前三十六頁\總數(shù)四十九頁\編于二十二點NephrosisduttocholesterolcrystalembolizationEpidemiology：authorpopulationcasesincidence(%)FloryAortaAS2673.3Orossautopsy37222.4JonesUnexplainedrenaldysfunction2451.0Preston>65years3344.2etiologicalfactor：AS、endovascularprocedure目前三十七頁\總數(shù)四十九頁\編于二十二點Henry(Percusurge)AJCOct,2000TCT30RASof24Pt.(27ostial)Allhadrenalimpairement,71%hadHTSuccessrate100%Occlusiontime418sec(149-797)Embolizationafterstenting目前三十八頁\總數(shù)四十九頁\編于二十二點EmbolizationafterstentingImprovedrenalfunction46%Unchanged4%Acutedeterioration0%Norenalfunctiondeterioretionat6month6/30(20%)empty24/30(80%)hadfiltercontentChronicthrombusCholesterolcleftsfragment目前三十九頁\總數(shù)四十九頁\編于二十二點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

目前四十頁\總數(shù)四十九頁\編于二十二點Kidneyinelderly目前四十一頁\總數(shù)四十九頁\編于二十二點Contrastinducednephrosis(CIN)AcuterenalimpairmentaftercontrastapplicationScrincrease>44.2μmol/LOr,increase>25%comparedtobaselinePrevalence:unselectedPt.:1-6%，Highrisk40-50%

目前四十二頁\總數(shù)四十九頁\編于二十二點RiskfactorsrelatedtoCINExistedrenaldysfunctionDMVasculardiseaseElderlyLowerEFhypovolemiadehydrationCongestiveheartfailurenephroticsyndrome;LiverCirrhosisBergKJ,ScandJUrolNephrol2000;34:317-322目前四十三頁\總數(shù)四十九頁\編于二十二點EffectofDMandrenalfunctionontheincidenceofCIN(n=1196）RI：renalimpairmentDM：diabetes

Rudnicketal.(1995)0510152025+RI+DM+RI–DM–RI+DM–RI–DM0%5.7%19.7%%0.6%目前四十四頁\總數(shù)四十九頁\編于二十二點EffectofDMandrenalfunctiononCINwithdifferentcontrastapplication0102030405060*定義為血清肌酐升高＞44.2μmol/l或＞25%（Laμtinetal.應用的標準為＞26.5μmol/l或＞20%）**基線血清肌酐＞133μmol/l（Barrettetal.的研究中＞124μmol/l）Patients(%)VisipaqueOmnipaqueorthersAspelinetal.2003Manskeetal.1990Wangetal.2000Rudnicketal.1995Taliercioetal.1991Lautinetal.1991Barrettetal.1992目前四十五頁\總數(shù)四十九頁\編于二十二點RenalarterystentingrestonosisauthorscasesF/Urestenosis(%)Shammas1322-20月26Wienklin403.3年12.5Zeller1564年11.4IIkay2614.3Yutan88531QueenMaryhospital641212.5RuijinHospital1086-20月11.5目前四十六頁\總數(shù)四十九頁\編于二十二點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目前四十七頁\總數(shù)四十九頁\編于二十二點

PreservationofRenalFunctionClassIIaRASandprogressivechronickidneydiseasewithbilateralRASoraRAStoasolitaryfunctioningki