The purpose of this prospective randomized study was to compare percutaneous transluminal
renal angioplasty (PTRA) and operation as initial therapy with regard to technical
results, primary and secondary patency, and effects on blood pressure and renal function
in patients with atherosclerotic unilateral renal artery stenosis.
Fifty-eight patients who did not have diabetes, who were less than 70 years of age,
and who had severe hypertension and significant stenosis were randomized to receive
PTRA or operation. Angiography was performed 10 days, 1 year, and 2 years after treatment
to verify patency, and blood pressure and renal function were simultaneously evaluated.
Technically, PTRA was successful in 83% and operation in 97% of patients. The primary
patency rate after 24 months was 75% in the PTRA group and 96% in the operative group
in technically successful cases. The secondary patency rate in the PTRA group was
90% and in the surgical group 97%. To achieve these results four patients in the PTRA
group required operation, and one patient in the surgical group required PTRA. Hypertension
was cured or improved after additional treatment in 90% of the patients after PTRA
and 86% after operation. The corresponding figures for improved or unchanged renal
function were 83% and 72%, respectively. After additional treatment, effects on blood
pressure and renal function did not differ. Seventeen percent of the patients treated
with PTRA required surgical intervention.
PTRA is recommended as first choice of therapy for atherosclerotic renal artery stenosis
causing renovascular hypertension if combined with intensive follow-up and aggressive