The Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) study: rationale and methods.
Department of Diagnostic Imaging, Rhode Island Hospital, Providence 02903, and Department of Medicine, Medical University of Ohio, Toledo, USA.Journal of Vascular and Interventional Radiology (Impact Factor: 2). 11/2005; 16(10):1295-300. DOI:10.1097/01.RVI.0000176301.69756.28
- Catheterization and Cardiovascular Interventions 02/2012; 79(3):437-8. · 2.51 Impact Factor
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ABSTRACT: Aims The aim of this study was to document the early outcome of coronary-like revascularization for atherosclerotic renal artery stenosis (ARAS). Methods and results A total of 181 consecutive patient, 102 men, mean age 66.1 (± 9.2) years and 79 females, mean age 68.4 (± 9.2) years and 198 lesions were treated between February 1999 and May 2004 for ARAS and retrospectively analyzed. At least one major cardiovascular risk factor was present in 179 (98.9%) patients. Pre-dilatation ARAS was 81.3±9.6%, 27 ARAS were 50–60% and no ARAS was <50%. 135 (68.2%) of the ARAS lesions were ostial and 63 (31.8%) were non-ostial. In 17 (9.4%) patients bilateral ARAS were present. Technical success defined as residual stenosis ≥50% was achieved in 178 (98.3%) of patients and 195 (98.5%) of lesions. In one patient (0.5%) the target ARAS could not be crossed, in two (1.1%) patients residual stenosis was >30%. No major adverse cardiac or cerebral effects were observed. In 3.9% of patients minor local complications of the access site occurred; 4 (2.2%) inguinal hematoma, 3 (1.7%) pseudoaneurysm were documented. Serum creatinine concentrations and systolic and diastolic blood pressure before and after the intervention were not statistically different. Conclusions Coronary-like approach to ARAS revascularization is technically feasible and associated with a very low complication rate.Clinical Research in Cardiology 04/2012; 95(11):584-590. · 3.67 Impact Factor
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ABSTRACT: Background Renovascular hypertension (RVH) is characterized by chronic inflammation of the stenotic kidney and progressive renal dysfunction. Neutrophil gelatinase-associated lipocalin (NGAL), an acute phase protein induced in inflammatory conditions and ischemia, is a novel biomarker for acute kidney injury. We hypothesized that chronic RVH would be associated with increased renal and circulating NGAL levels.Methods We prospectively measured renal vein and inferior vena cava (IVC) levels of NGAL and inflammatory cytokines in essential hypertensive (EH) and RVH patients, during constant sodium intake and anti-hypertensive regimens, and compared them with systemic levels in age-matched normotensive subjects (n = 22 each). In addition, we measured urinary NGAL and kidney injury molecule (KIM)-1 in all patients.ResultsBlood pressure, serum creatinine, estimated glomerular filtration rate (eGFR), lipid panels and medications were similar in RVH and EH. Systemic, stenotic and contralateral renal vein levels of NGAL were all similarly elevated in RVH versus normal hypertension and EH (P < 0.05), as were renal vein levels of inflammatory markers like tumor necrosis factor-α. Furthermore, renal vein NGAL levels inversely correlated with eGFR, and directly with renal vein (but not systemic) levels of inflammatory markers. Urinary levels of NGAL and KIM-1 were elevated in both EH and RVH, as were systemic levels of C-reactive protein.Conclusions Chronic RVH is associated with elevated NGAL levels, likely due to ongoing kidney and systemic inflammation and ischemia. These findings may also imply the occurrence of the inflammation process in chronic RVH, which might contribute to the poorer outcomes of RVH compared with EH patients.Nephrology Dialysis Transplantation 08/2012; · 3.37 Impact Factor
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