Successful reintroduction of previously failed ACE inhibitor therapy following stenting of atherosclerotic renovascular disease.

ABSTRACT

BACKGROUND: Angiotensin Converting Enzyme (ACE) inhibitors improve outcomes in patients with coronary artery disease irrespective of the status of the left ventricle. In the presence of functionally significant renovascular disease, ACE inhibitors often cause deterioration of renal function leading to their withdrawal. DESIGN: Observational study with 6 months prospective follow-up. METHODS AND RESULTS: Six patients with coronary artery disease and previous ACE inhibitor induced deterioration in renal function underwent renal artery stenting for angiographically-confirmed unilateral renal artery stenosis. Pre-existing significant renal dysfunction was present in 4 patients. Immediate technical success was achieved in all patients. ACE inhibitors were successfully reintroduced and titrated to maximum-tolerated in all 6 patients. At 6 months, one patient died due to progressive heart failure. The other patients remained tolerant of ACE inhibitor treatment with stable or improved renal function. CONCLUSION: Renal angiography should be considered in patients with coronary artery disease and ACE inhibitor induced renal dysfunction. Successful renal artery stenting permits reintroduction of ACE inhibitor with satisfactory maintenance of renal function at 6 months.