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Kardiologie up2date 2011; 7(2): 125-139
DOI: 10.1055/s-0030-1256618
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© Georg Thieme Verlag KG Stuttgart · New York

Nierenarterienstenose

Thomas  Zeller, Elias  Noory, Aljoscha  Rastan
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Publication History

Publication Date:
21 July 2011 (online)

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Abstract

Atherosclerotic renal artery stenosis (aRAS) is a disease of the advanced age and may result in deterioration of blood pressure control, renal function and myocardial dysfunction. Since the implementation of stenting endovascular treatment has replaced surgical revascularisation. The benefit of endovascular treatment of aRAS was challenged by the results of the STAR and ASTRAL trials resulting in similar outcomes of revascularisation and conservative treatment. However, these trial results can only be applied to a small proportion of the affected patients due to severe limitations of the both trial designs. Proper indication for renal stenting is the key for clinical success of the endovascular procedure. Most relevant is the identification of the hemodynamically relevance of the lesion by non-invasive (duplex) and invasive (pressure gradient) methods. Moreover, recently some clinical success predictors had been identified which are not yet sufficiently implemented in the decision making process. Unquestioned is the indication for revascularisation in RAS of single functioning kidneys, severe bilateral lesions and in each kind of RAS of non-atherosclerotic nature.

Kernaussagen

  • Die arteriosklerotische Nierenarterienstenose (aNAS) ist eine Erkrankung des höheren Lebensalters, die u. a. die Blutdruckeinstellung verschlechtern, die Nierenfunktion beeinträchtigen und zur myokardialen Dysfunktion führen kann.

  • Seit Einführung der Stentimplantation hat die Angioplastie die Gefäßchirurgie als Therapie der Wahl abgelöst. Der Nutzen revaskularisierender Maßnahmen auf die Verbesserung der Blutdruckkontrolle und die Nierenfunktion ist seit Publikation der ASTRAL- und STAR-Studien umstritten. Allerdings wird bei den Diskussionen häufig missachtet, dass die genannten Studienergebnisse nur auf einen kleinen Teil der betroffenen Patienten übertragen werden können.

  • Essenziell für einen klinischen Behandlungserfolg der Revaskularisation ist die korrekte Indikationsstellung, wesentlich dabei der Nachweis der hämodynamischen Relevanz einer Stenose durch nicht invasive (Duplexsonografie) und invasive Methoden (Druckgradientenmessung). Zudem existieren einige klinische Prädiktoren, denen bei der Therapieentscheidung noch zu selten Beachtung geschenkt wird.

  • Unbestritten ist die Indikation zur Revaskularisation bei hämodynamisch relevanten Stenosen funktioneller Einzelnieren, bilateraler Stenose und jeder Form einer relevanten Stenose nicht arteriosklerotischer Genese.

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Prof. Dr. Thomas Zeller

Herz-Zentrum Bad Krozingen
Abteilung Angiologie

Südring 15
79189 Bad Krozingen

Email: thomas.zeller@herzzentrum.de