Ultra-Low dose contrast using Transluminal Renal Angioplasty (ULTRA study)

Abstract BackgroundSevere atherosclerotic renal artery stenosis (ARAS) is a predictor of future cardiovascular events and should be managed effectively. This study aimed to validate the safety and efficacy of percutaneous transluminal renal angioplasty (PTRA) using low concentration digital subtraction angiography (LC-DSA) among patients with severe ARAS and advanced chronic kidney disease (CKD).MethodsThis prospective study conducted between August 2018 and August 2020. Patients with CKD stage 3b or worse and significant renal artery stenosis were included in this study and underwent PTRA with ultra-low dose contrast medium. The primary endpoint was a change in renal function, based on serum creatinine (sCr) levels.ResultsThirteen lesions of eleven patients underwent PTRA for ARAS with ultra-low dose contrast medium. Mean sCr level has significantly improved from 3.18 ± 1.8 mg/dL (before procedure) to 2.34 ± 1.17 mg/dL (one month after treatment) (p =0.039). The mean amount of used contrast was 8.8 ± 4.0 ml per vessel. Patients with renal artery stenosis >80%, peak systolic velocity >300 cm/m2, or CKD Stage 3b were analyzed. More severe stenosis and rapid deterioration of renal function before treatment were associated with improved kidney function. No cardiovascular and renal complications, such as stroke or contrast-induced nephropathy, were noted in any of the patients.ConclusionsPTRA with ultra-low dose contrast medium is safe and provides good results.Trial registration: Investigation for optimal protocol using diluted ionic contrast medium during angiography, UMIN000034174. Registered 26 September 2018, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038955