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Contrast-induced nephropathy following renal artery stenting: predictors and outcomes
S42
’
Sunday
Scientific Session
SUNDAY: Scientific Sessions
Interventional Radiology, Dublin, Ireland; 3Department of Cardiology and Angiology, Hannover, Germany; 4 Hanover Medical School, Hannover, Germany; 5 Beaumont Hospital, Dublin, Ireland; 6Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover, Germany; 7Department of Diagnostic and Interventional Radiology, Hannover, Germany Purpose: To evaluate a novel 2D-perfusion angiography (2DPA) technique allowing pro- and retrospective flow analysis based on a proximal reference region of interest (ROI) and distal target ROI in patients treated for peripheral arterial disease. Materials: 2D-PA allows quantifying blood flow by postprocessing of digital subtraction angiography (DSA). 2D-PA was performed pre- and post-interventional treatment of peripheral arterial disease (n ¼ 24; 13 PTAs, 11 stents) in 21 patients (17men, 72 ⫾ 9y) applying a proximal reference ROI (arterial inflow) and a target ROI distal to the treated lesion. Time-to-peak (TTP), peak density (PD) and area-under-the-curve (AUC) were calculated. Ratios of the reference and the target ROI (TTPROI/ TTPREF; PDROI/PDREF; AUCROI/AUCREF) were calculated and correlated to chances in the ankle-brachial-index (ABI). Results: 2D-PA was technically feasible allowing quantitative flow analysis in all cases. A significant ABI increase was seen after interventional treatment (0.69 ⫾ 0.16 vs. 0.96 ⫾ 0.19 (39%), po0.0001). ABI increase was accompanied by an increase of 36% of PDROI/PDRef (0.72 ⫾ 0.44 vs. 0.98 ⫾ 0.43; po0.0001), a 52% decrease of TTPROI/TTPREF (1.81 ⫾ 1.37 vs. 0.95 ⫾ 0.89; p ¼ 0.0007) and a 69% increase of AUCROI/AUCREF (0.69 ⫾ 0.5 vs. 1.17 ⫾ 0.58; po0.0001). The difference of TTP pre- and post-intervention showed a correlation with the difference in ABI (r ¼ -0.53, p ¼ 0.0081). The other measured parameters missed significant correlation with improvement of ABI. Conclusions: The presented 2D-PA technique allows quantitative assessment of arterial flow before, during and after interventional treatment. Furthermore, this technique has great potential for individual therapeutic optimisation and quantification of technical success for scientific purposes, respectively.
3:09 PM
Abstract No. 91
Contrast-induced nephropathy following renal artery stenting: predictors and outcomes E. Takahashi1, M. McKusick1, H. Bjarnason1, K. Mara1, W. Harmsen1, S. Misra1; 1Mayo Clinic, Rochester, MN Purpose: To determine the predictors and clinical outcomes of contrast-induced nephropathy (CIN) following renal artery stenting. Materials: We retrospectively reviewed the clinical data of 1052 patients who underwent renal artery stenting for atherosclerotic renal artery stenosis from 1996-2009, with clinical follow-up to 2015. A total of 437 patients with adequate follow-up were included in this study. Baseline laboratory values, medications, prehydration, contrast medium and total iodine administered during stenting were evaluated. The presence of CIN was determined using the Acute Kidney Injury Network (AKIN) criteria (absolute serum creatinine increase Z0.3 mg/dL or percentage increase in serum creatinine Z50% within 48 hours
’
JVIR
of intervention). The impact of CIN on time to dialysis and mortality was recorded. Results: Mean follow-up duration was 71.1 ⫾ 68.4 months. Mean baseline creatinine was 1.4 mg/dL. Based on AKIN criteria, 26 patients (5.9%) developed CIN. These patients had significantly higher baseline proteinuria levels compared to those who did not develop CIN (odds ratio 1.38; 95% CI 1.111.72; P ¼ 0.004). No significant difference in prehydration, chronic kidney disease stage, baseline GFR, statin use, contrast volume and iodine mass was observed between the two groups. Time to dialysis and mortality rates were not significantly different between patients with and without CIN. Conclusions: Elevated baseline proteinuria was the only predictor for CIN in patients undergoing renal artery stenting. Patients who develop CIN are not at higher risk for dialysis or death.
3:18 PM
Abstract No. 92
Effectiveness of the Zilver PTX drug-eluting stent for femoropopliteal peripheral arterial disease in patients with no tibial runoff vessels: 24-month results from the Zilver PTX Post-Market Study in Japan S. Cipollari1, H. Yokoi2, T. Ohki3, K. Kichikawa4, M. Nakamura5, K. Komori6, S. Nanto7, E. O’Leary8, A. Lotters8, S. Snyder8, M. Dake9; 1Stanford, Stanford, CA; 2 Fukuoka Sanno Hospital, Fukuoka, Fukuoka; 3Jikei University Hospital, Minato-ku, Tokyo; 4Nara Medical University, Kashihara, Nara, Japan; 5Toho University Ohashi Medical Center, Meguro-ku, Tokyo; 6Nagoya University Graduate School of Medicine, Showa-ku, Nagoya; 7 Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo; 8Cook Research Incorporated, West Lafayette, IN; 9 Falk Cardiovascular Research Center, Stanford, CA Purpose: Poor tibial runoff is a known negative predictor of long-term effectiveness following revascularization of the femoropopliteal artery. The objective of this study was to evaluate the 24-month results of the Zilver PTX drug-eluting stent (DES) for treatment of femoropopliteal peripheral arterial disease (PAD) in patients with no continuous infrapopliteal runoff arteries compared to patients with one or more continuous runoff vessels. Materials: A retrospective analysis of patients with femoropopleteal PAD enrolled in the Zilver PTX Post-Market Surveillance Study in Japan was performed. Outcomes, including freedom from target lesion revascularization (TLR), patency, and clinical benefit, for the no-runoff group (n ¼ 54) were compared to the runoff group (n ¼ 846). Results: Demographics, lesion characteristics, and comorbidities were similar for the two groups (p4.05). There was a higher incidence of critical limb ischemia in the no-runoff group compared to the runoff group (44.8% vs. 19.7%, po.0001). At 24 months, freedom from TLR rates were 82.5% vs. 83.8% (p ¼ .97), patency rates were 68.4% vs. 70.7% (p ¼ .95), and clinical benefit rates were 75.3% vs. 79.9% (p ¼ .26) in the no-runoff and runoff group, respectively. Conclusions: Results in patients with no continuous tibial runoff were favorable through 24 months, suggesting that the
’
Sunday
Scientific Session
SUNDAY: Scientific Sessions
Interventional Radiology, Dublin, Ireland; 3Department of Cardiology and Angiology, Hannover, Germany; 4 Hanover Medical School, Hannover, Germany; 5 Beaumont Hospital, Dublin, Ireland; 6Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover, Germany; 7Department of Diagnostic and Interventional Radiology, Hannover, Germany Purpose: To evaluate a novel 2D-perfusion angiography (2DPA) technique allowing pro- and retrospective flow analysis based on a proximal reference region of interest (ROI) and distal target ROI in patients treated for peripheral arterial disease. Materials: 2D-PA allows quantifying blood flow by postprocessing of digital subtraction angiography (DSA). 2D-PA was performed pre- and post-interventional treatment of peripheral arterial disease (n ¼ 24; 13 PTAs, 11 stents) in 21 patients (17men, 72 ⫾ 9y) applying a proximal reference ROI (arterial inflow) and a target ROI distal to the treated lesion. Time-to-peak (TTP), peak density (PD) and area-under-the-curve (AUC) were calculated. Ratios of the reference and the target ROI (TTPROI/ TTPREF; PDROI/PDREF; AUCROI/AUCREF) were calculated and correlated to chances in the ankle-brachial-index (ABI). Results: 2D-PA was technically feasible allowing quantitative flow analysis in all cases. A significant ABI increase was seen after interventional treatment (0.69 ⫾ 0.16 vs. 0.96 ⫾ 0.19 (39%), po0.0001). ABI increase was accompanied by an increase of 36% of PDROI/PDRef (0.72 ⫾ 0.44 vs. 0.98 ⫾ 0.43; po0.0001), a 52% decrease of TTPROI/TTPREF (1.81 ⫾ 1.37 vs. 0.95 ⫾ 0.89; p ¼ 0.0007) and a 69% increase of AUCROI/AUCREF (0.69 ⫾ 0.5 vs. 1.17 ⫾ 0.58; po0.0001). The difference of TTP pre- and post-intervention showed a correlation with the difference in ABI (r ¼ -0.53, p ¼ 0.0081). The other measured parameters missed significant correlation with improvement of ABI. Conclusions: The presented 2D-PA technique allows quantitative assessment of arterial flow before, during and after interventional treatment. Furthermore, this technique has great potential for individual therapeutic optimisation and quantification of technical success for scientific purposes, respectively.
3:09 PM
Abstract No. 91
Contrast-induced nephropathy following renal artery stenting: predictors and outcomes E. Takahashi1, M. McKusick1, H. Bjarnason1, K. Mara1, W. Harmsen1, S. Misra1; 1Mayo Clinic, Rochester, MN Purpose: To determine the predictors and clinical outcomes of contrast-induced nephropathy (CIN) following renal artery stenting. Materials: We retrospectively reviewed the clinical data of 1052 patients who underwent renal artery stenting for atherosclerotic renal artery stenosis from 1996-2009, with clinical follow-up to 2015. A total of 437 patients with adequate follow-up were included in this study. Baseline laboratory values, medications, prehydration, contrast medium and total iodine administered during stenting were evaluated. The presence of CIN was determined using the Acute Kidney Injury Network (AKIN) criteria (absolute serum creatinine increase Z0.3 mg/dL or percentage increase in serum creatinine Z50% within 48 hours
’
JVIR
of intervention). The impact of CIN on time to dialysis and mortality was recorded. Results: Mean follow-up duration was 71.1 ⫾ 68.4 months. Mean baseline creatinine was 1.4 mg/dL. Based on AKIN criteria, 26 patients (5.9%) developed CIN. These patients had significantly higher baseline proteinuria levels compared to those who did not develop CIN (odds ratio 1.38; 95% CI 1.111.72; P ¼ 0.004). No significant difference in prehydration, chronic kidney disease stage, baseline GFR, statin use, contrast volume and iodine mass was observed between the two groups. Time to dialysis and mortality rates were not significantly different between patients with and without CIN. Conclusions: Elevated baseline proteinuria was the only predictor for CIN in patients undergoing renal artery stenting. Patients who develop CIN are not at higher risk for dialysis or death.
3:18 PM
Abstract No. 92
Effectiveness of the Zilver PTX drug-eluting stent for femoropopliteal peripheral arterial disease in patients with no tibial runoff vessels: 24-month results from the Zilver PTX Post-Market Study in Japan S. Cipollari1, H. Yokoi2, T. Ohki3, K. Kichikawa4, M. Nakamura5, K. Komori6, S. Nanto7, E. O’Leary8, A. Lotters8, S. Snyder8, M. Dake9; 1Stanford, Stanford, CA; 2 Fukuoka Sanno Hospital, Fukuoka, Fukuoka; 3Jikei University Hospital, Minato-ku, Tokyo; 4Nara Medical University, Kashihara, Nara, Japan; 5Toho University Ohashi Medical Center, Meguro-ku, Tokyo; 6Nagoya University Graduate School of Medicine, Showa-ku, Nagoya; 7 Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo; 8Cook Research Incorporated, West Lafayette, IN; 9 Falk Cardiovascular Research Center, Stanford, CA Purpose: Poor tibial runoff is a known negative predictor of long-term effectiveness following revascularization of the femoropopliteal artery. The objective of this study was to evaluate the 24-month results of the Zilver PTX drug-eluting stent (DES) for treatment of femoropopliteal peripheral arterial disease (PAD) in patients with no continuous infrapopliteal runoff arteries compared to patients with one or more continuous runoff vessels. Materials: A retrospective analysis of patients with femoropopleteal PAD enrolled in the Zilver PTX Post-Market Surveillance Study in Japan was performed. Outcomes, including freedom from target lesion revascularization (TLR), patency, and clinical benefit, for the no-runoff group (n ¼ 54) were compared to the runoff group (n ¼ 846). Results: Demographics, lesion characteristics, and comorbidities were similar for the two groups (p4.05). There was a higher incidence of critical limb ischemia in the no-runoff group compared to the runoff group (44.8% vs. 19.7%, po.0001). At 24 months, freedom from TLR rates were 82.5% vs. 83.8% (p ¼ .97), patency rates were 68.4% vs. 70.7% (p ¼ .95), and clinical benefit rates were 75.3% vs. 79.9% (p ¼ .26) in the no-runoff and runoff group, respectively. Conclusions: Results in patients with no continuous tibial runoff were favorable through 24 months, suggesting that the