Use of Coronary Covered Stent Grafts in the Management of Atherosclerotic Renal Artery Stenosis
2Interventional Radiology Unit, Sheba Medical Center
3Cardiac Imaging Unit, Sheba Medical Center
4Division of Interventional Radiology, Cleveland Clinic, USA
Background:
Renal artery stenosis (RAS), mostly caused by atherosclerosis, may present with treatment-resistant hypertension and progressive decline in renal function. Endovascular revascularization is the preferred form of intervention. Coronary covered stents (CCS) may provide an appealing alternative to standard peripheral stents, due to their low-profile design and flexibility which facilitate their delivery in small-calibre, tortuous vessels.
Methods:
This single-center retrospective study included adults treated for RAS with a BeGraft Coronary covered stent-graft (Bentley InnoMedGmbH, Hechingen, Germany) between May 2020 and June 2025. Exclusion criteria were acute indications, prior stenting and use of non-coronary stents. Primary endpoint was clinically relevant restenosis. Secondary endpoints included technical and procedural success, complications, radiographic restenosis and clinical response.
Results:
Twenty-four patients underwent 24 procedures treating 31 renal arteries. Technical and procedural success rates were 100%. Radiographic restenosis was observed in 7/31 (23%) arteries (median 254 days), while only 3/31 (10%) were clinically significant, requiring reintervention. All reinterventions were successful. Primary patency was 92% and 79% at 6 months and 1 year, respectively. Combined primary, primary assisted and secondary patency at last available imaging (median 619 days) was 81%. Post-procedural complications occurred in 9/24 procedures (37%). Death rate at follow up was 5/24 (21%). Median serum creatinine decreased from 1.77 to 1.53 mg/dL(p=0.229) and mean blood pressure decreased from 168/78 to 135/71 mmHg (0=0.028) at first follow up. Renal function improved in 7/24 patients (29%) and remained stable in 13/24 (54%). Antihypertensive medication burden decreased in 14/22 (64%) and was stable in 7/22 (32%).
Conclusions:
Revascularization of the renal arteries using CCS achieved high technical success and favorable clinically driven patency, with effective endovascular salvage when required. Complications were not uncommon, reflecting the need for careful management of this high-risk population. Prospective studies with standardized follow-up are needed to better define durability and clinical benefit.