Transluminal angioplasty of the renal arteries in patients with fibromuscular dysplasia

Objective: FMD is the second most frequent cause of renal artery stenosis (RAS) after atherosclerosis and can lead to hypertension. To cure or improve this renovascular hypertension, patient with fibromuscular dysplasia and renal artery stenosis undergo renal artery revascularization by percutaneous renal transluminal angioplasty (PTRA). Although this method has been performed for many years, there have been only few small size trials published. This retrospective single center study aimed to evaluate the rate of cured hypertension after PTRA. Design and method: We included all adult patients diagnosed with FMD who were seen in our referral center for hypertension management (Hôpital Européen Georges Pompidou, Paris) from January 2010 to March 2020. Blood pressure response was assessed at 3 month and one year. Primary outcome was one year cured hypertension rate in ambulatory measurement, secondary outcomes were improvement and complication rate. Results: Overall, 76 adult patients (87% female, mean age at enrollment 35.5 years) were included. FDM was multifocal in 74% and unisite in 68% of patients. AT baseline, mean day ambulatory blood pressure (dABP) was 141 ± 17/89 ± 14 mmHg under a mean of 2.3 ± 1.37 antihypertensive treatments. All patient underwent PTRA. Stent were inserted in 8 patients (10.5%) with residual stenosis after PTRA and in 8 patients (10.5%) with renal artery dissection, total complication rate was 18.4%. At one-year follow-up, mean dABP was 128 ± 12/78 ± 9 mmHg (p < 0.0001) with 1.1 ± 1.3 treatments (p < 0.0001). In total, 75% beneficiated from renal angioplasty: 31% were cured and 44% were improved. Cured hypertension was associated with low body mass index (BMI) (p = 0.017) and unisite FDM (p = 0.017) on a multivariable analysis. Conclusions: In patients with FMD, PTRA is associated with cured hypertension 31% of patients with renal artery FMD undergoing PRTA. Hypertension is more likely to be cured in patient with low BMI and multisite FMD. These results are to be put in perspective with a complication rate of 18.4%.