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Renal artery stenosis (RAS) is one of the potential manifestations of peripheral artery diseases and it is often observed in patients with evolving renal function impairment and concomitant coronary artery disease, or in those suffering from hypertension refractory to medical therapy.Percutaneous renal artery stenting is an effective therapeutic tool and represents the treatment of choice for RAS. Identification of parameters able to discriminate patients who benefit from RAS stenting, thus, has become of crucial importance if this technique has to survive.
Aortic dissection represents a common cardiovascular disease and it is responsible for the most commonly encountered pathologies in aortic emergency. Renal dysfunction is a common complication associated with aortic dissection, with resultant high mortality rate. The antegrade propagation of the dissection from the proximal aorta to the level of renal arteries and the intervention during surgery may both increase the risk of renal malperfusion; thus, it is important to assess renal function for pre- and post-operative evaluation and guidance for treatment. This can be achieved through perfusion imaging.
Presently, C-arm Cone Beam Computed Tomography (CBCT) perfusion is well established, in particular, in the diagnostic assessment of acute stroke and cerebral ischemia. The main novelty of our study lies in the fact that intra-procedural renal perfusion assessed for the first time semiquantitatively by Syngo Dyna Parenchymal Blood Volume(PBV) software, discriminate patients who will benefit from the intervention procedure.
In conclusion, our study suggests that a routine assessment of pre, and post-stenting renal perfusion could help to identify patients at higher risk of no improvement or even worsening of renal function after stenting and, perhaps, more aggressive medical therapy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with Renal Artery Stenosis | Patients with simple renal artery stenosis or aortic dissection with renal artery obstruction |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Endovascular therapy and Imaging Acquisition | Procedure |
|
| Measure | Description | Time Frame |
|---|---|---|
| Glomerular Filtration Rate | The golden standard of renal function, tested by radionuclide imaging | Change from Baseline Glomerular Filtration Rate at 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Kidney Volume | Total blood volume of kidney, tested by PBV | 10 minutes pre- and post-endovascular therapy on table |
| Mean Density of Contrast agent | Renal blood perfusion, tested by PBV |
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Inclusion Criteria:
Exclusion Criteria:
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Consecutive patients who meet the inclusion criteria, are willing to comply with this protocol, and receive endovasculara therapy in the Department of Vascular Surgery, Zhongshan Hospital will be included.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Zhenyu Shi, PhD | Contact | 021 6404 1990 | 2904 | maxshizhenyu@163.com |
| Name | Affiliation | Role |
|---|---|---|
| Zhenyu Shi, PhD | Fudan University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zhongshan Hospital, Fudan University | Recruiting | Shanghai | Shanghai Municipality | 200032 | China |
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| ID | Term |
|---|---|
| D012078 | Renal Artery Obstruction |
| D000784 | Aortic Dissection |
| ID | Term |
|---|---|
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
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| 10 minutes pre- and post-endovascular therapy on table |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D000094665 | Dissection, Blood Vessel |
| D000783 | Aneurysm |
| D000094683 | Acute Aortic Syndrome |
| D001018 | Aortic Diseases |