Angiographic Index for Angioplasty-Treatable Atheromatous Renal Artery Stenosis

Article metrics


The relative reduction of the lumen diameter by an atheromatous lesion (% diameter reduction) is generally used as an angiographic index for atheromatous renal artery stenosis (ARAS), but its association with the clinical outcome of angioplasty has not been sufficiently evaluated. This study aimed to identify an angiographic index(ices) that can be used to identify angioplasty-treatable ARAS. We evaluated the clinical outcome of angioplasty in 27 patients who had unilateral ARAS without renal insufficiency by assessing the reduction in systemic arterial blood pressure (BP) after angioplasty and examined its association with various angiographic indices. In the receiver operating characteristic analysis for BP reduction, the area under the curve was larger for the absolute value of the lumen diameter at the narrowest part of its constriction (the narrowest diameter), an angiographic index introduced in this study, than for % diameter reduction (0.770 vs. 0.731). At a 3-mm maximum threshold, the narrowest diameter identified cases with BP reduction; the sensitivity/specificity was 0.89/0.75 (p<0.001). Furthermore, the narrowest diameter correlated better than % diameter reduction with hemodynamic indices of ARAS. In conclusion, the narrowest diameter is an angiographic index that can effectively identify angioplasty-treatable ARAS in patients without renal insufficiency.


  1. 1

    Safian RD, Textor SC : Renal-artery stenosis. N Engl J Med 2001; 344: 431–442.

  2. 2

    Bokhari SW, Faxon DP : Current advances in the diagnosis and treatment of renal artery stenosis. Rev Cardiovasc Med 2004; 5: 204–215.

  3. 3

    Preston RA, Epstein M : Ischemic renal disease: an emerging cause of chronic renal failure and end-stage renal disease. J Hypertens 1997; 15: 1365–1377.

  4. 4

    van Ampting JM, Penne EL, Beek FJ, Koomans HA, Boer WH, Beutler JJ : Prevalence of atherosclerotic renal artery stenosis in patients starting dialysis. Nephrol Dial Transplant 2003; 18: 1147–1151.

  5. 5

    Rundback JH, Gray RJ, Rozenblit G, et al: Renal artery stent placement for the management of ischemic nephropathy. J Vasc Interv Radiol 1998; 9: 413–420.

  6. 6

    van Jaarsveld BC, Krijnen P, Pieterman H, et al: The effect of balloon angioplasty on hypertension in atherosclerotic renal-artery stenosis. Dutch Renal Artery Stenosis Intervention Cooperative Study Group. N Engl J Med 2000; 342: 1007–1014.

  7. 7

    Tanemoto M, Saitoh H, Satoh F, Satoh H, Abe T, Ito S : Predictors of undiagnosed renal artery stenosis among Japanese patients with risk factors of atherosclerosis. Hypertens Res 2005; 28: 237–242.

  8. 8

    Uzu T, Takeji M, Yamada N, et al: Prevalence and outcome of renal artery stenosis in atherosclerotic patients with renal dysfunction. Hypertens Res 2002; 25: 537–542.

  9. 9

    Pijls NH, van Son JA, Kirkeeide RL, De Bruyne B, Gould KL : Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation 1993; 87: 1354–1367.

  10. 10

    Lamm C, Dohnal M, Serruys PW, Emanuelsson H : High-fidelity translesional pressure gradients during percutaneous transluminal coronary angioplasty: correlation with quantitative coronary angiography. Am Heart J 1993; 126: 66–75.

  11. 11

    Wijns W, Serruys PW, Reiber JH, et al: Quantitative angiography of the left anterior descending coronary artery: correlations with pressure gradient and results of exercise thallium scintigraphy. Circulation 1985; 71: 273–279.

  12. 12

    Reidy J : Contrast arteriography, in Novick AC (ed): Renal Vascular Disease, 1st ed. London, WB Saunders Company Ltd, 1996, pp 77–90.

  13. 13

    van Jaarsveld BC, Pieterman H, van Dijk LC, et al: Inter-observer variability in the angiographic assessment of renal artery stenosis. DRASTIC study group. Dutch Renal Artery Stenosis Intervention Cooperative. J Hypertens 1999; 17: 1731–1736.

  14. 14

    Schreij G, de Haan MW, Oei TK, Koster D, de Leeuw PW : Interpretation of renal angiography by radiologists. J Hypertens 1999; 17: 1737–1741.

  15. 15

    Rundback JH, Sacks D, Kent KC, et al: Guidelines for the reporting of renal artery revascularization in clinical trials. American Heart Association. Circulation 2002; 106: 1572–1585.

  16. 16

    Stergiou GS, Efstathiou SP, Alamara CV, Mastorantonakis SE, Roussias LG : Home or self blood pressure measurement? What is the correct term? J Hypertens 2003; 21: 2259–2264.

  17. 17

    Myers MG, Tobe SW, McKay DW, Bolli P, Hemmelgarn BR, McAlister FA : New algorithm for the diagnosis of hypertension. Am J Hypertens 2005; 18: 1369–1374.

  18. 18

    Colyer WR Jr, Cooper CJ, Burket MW, Thomas WJ : Utility of a 0.014″ pressure-sensing guidewire to assess renal artery translesional systolic pressure gradients. Catheter Cardiovasc Interv 2003; 59: 372–377.

  19. 19

    May AG, De Weese JA, Rob CG : Hemodynamic effects of arterial stenosis. Surgery 1963; 53: 513–524.

  20. 20

    Weidmann P, De Myttenaere-Bursztein S, Maxwell MH, de Lima J : Effect on aging on plasma renin and aldosterone in normal man. Kidney Int 1975; 8: 325–333.

  21. 21

    Levey AS, Coresh J, Greene T, et al: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145: 247–254.

  22. 22

    Weir MR, Dzau VJ : The renin-angiotensin-aldosterone system: a specific target for hypertension management. Am J Hypertens 1999; 12: 205S–213S.

  23. 23

    Muller FB, Sealey JE, Case DB, et al: The captopril test for identifying renovascular disease in hypertensive patients. Am J Med 1986; 80: 633–644.

  24. 24

    Radermacher J, Chavan A, Bleck J, et al: Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med 2001; 344: 410–417.

  25. 25

    Shimizu Y, Itoh T, Hougaku H, et al: Clinical usefulness of duplex ultrasonography for the assessment of renal arteriosclerosis in essential hypertensive patients. Hypertens Res 2001; 24: 13–17.

  26. 26

    Tan KT, van Beek EJ, Brown PW, van Delden OM, Tijssen J, Ramsay LE : Magnetic resonance angiography for the diagnosis of renal artery stenosis: a meta-analysis. Clin Radiol 2002; 57: 617–624.

Download references

Author information

Correspondence to Masayuki Tanemoto.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tanemoto, M., Abe, M., Uruno, A. et al. Angiographic Index for Angioplasty-Treatable Atheromatous Renal Artery Stenosis. Hypertens Res 31, 881–885 (2008) doi:10.1291/hypres.31.881

Download citation


  • hypertension
  • renin angiotensin system
  • renal ischemia
  • arteriosclerosis

Further reading