Atherosclerotic renal artery stenosis (RAS) affects nearly 7% of adults over age 65 and is associated with increased cardiovascular and renal morbidity. Although early observational studies suggested benefit from renal artery stenting, subsequent randomized trials failed to show improvement in major clinical endpoints, contributing to substantial declines in procedural use. To characterize contemporary practice, we conducted a retrospective cohort study of Medicare beneficiaries older than 65 years who underwent renal artery stenting for atherosclerotic RAS between 2016 and 2020. Using Medicare claims data, we evaluated baseline characteristics, temporal utilization, and postprocedural outcomes, stratified by race, geographic region, and dual Medicare-Medicaid enrollment status. Among 19,130 patients, the mean age was 76.0 years (±6.4), 59.2% were female, and 90.3% were White; 84.2% had chronic kidney disease and 48.7% had heart failure. Procedural rates declined by 41.1% over the study period. Compared with White patients, Black patients had higher adjusted risks of hypertensive crisis hospitalization (aHR 1.45, 95% CI, 1.24-1.70) and dialysis initiation (aHR 1.78, 95% CI, 1.39-2.27); patients of Other races also had greater risk of dialysis initiation (aHR 1.98, 95% CI, 1.50-2.63). Patients in the South experienced higher unadjusted cardiovascular event rates (50.0%) but similar adjusted mortality compared with those in the Northeast (aHR 1.09, 95% CI, 0.98-1.21). Dual enrollment was associated with increased all-cause mortality (aHR 1.31, 95% CI, 1.20-1.43). In conclusion, renal artery stenting rates continued to decline in recent years, and contemporary recipients constitute an older, comorbid population with substantial cardiovascular risk. Outcomes differed markedly by race, socioeconomic status, and geography, highlighting the need for improved risk stratification and prospective evaluation of stenting in high-risk cohorts.
Publications by Year: 2026
2026
AIMS: Multidisciplinary pulmonary embolism response teams (PERTs) are being established in hospitals worldwide to address the increasing complexity in acute PE management. To identify recent trends in PERT decisions regarding advanced treatment of acute severe PE.
METHODS AND RESULTS: We analysed data from the prospective multicentre PERT™ Consortium registry (years 2018-2024), focusing on catheter-directed treatment (CDT) and including systemic thrombolysis, surgical embolectomy, and extracorporeal membrane oxygenation (ECMO). An age-, sex-, and PE risk-matched population from the US Nationwide Inpatient Sample (NIS) was used for comparison. Among 11 436 patients enrolled at 51 sites (median age, 65 years; 13.7% high-risk and 62.5% intermediate-risk PE), 2639 (23.1%) underwent CDT. Of those, 140 (5.3%) underwent catheter-directed thrombolysis without ultrasound, 851 (32.2%) ultrasound-assisted catheter thrombolysis, and 1534 (58.1%) mechanical thrombectomy/aspiration. Systemic thrombolysis was used in 5.6%, surgical embolectomy in 1.1%, and ECMO in 1.6% of all patients. Trends of CDT increased over time (+0.36% quarterly by linear regression; P = 0.002), with increase in mechanical thrombectomy (+0.83%; P < 0.001) and decrease in catheter-directed thrombolysis (-0.4%; P = 0.001). Matching 10 883 patients from the PERT™ Consortium registry to the NIS population, we found a 22% (95% CI, 21-23%) standardized mean difference in CDT use, 1.3% (0.6-2.0%) lower in-hospital mortality, and 0.75 (0.2-1.3) fewer days of hospital stay among PERT™ Consortium registry patients.
CONCLUSION: In a national quality assurance database of patients with PE included in the PERT registry, the use of catheter-directed treatment increased over time. Compared with a nationwide NIS sample, these patients had lower in-hospital mortality and shorter hospital length of stay.
BACKGROUND: Radiation-induced atherosclerosis represents an underestimated clinical entity.
CASE SUMMARY: We report on 2 cases of patients with upper-limb ischemia due to subclavian artery lesions. Both patients had radiation therapy due to cancer more than 15 years before symptom onset and no other signs of atherosclerosis. Angiography and intravascular ultrasound were performed in both cases, and lesions were treated with angioplasty and stent placement in the first patient, whereas intravascular lithotripsy was necessary in the second patient due to severe calcification and balloon underexpansion.
DISCUSSION & TAKE-HOME MESSAGES: Intravascular ultrasound helps to accurately assess lesion characteristics, size the balloon and stent devices, and judge the effectiveness of the endovascular therapy. Since radiotherapy is linked to accelerated atherosclerosis, such patients may benefit from clinical and imaging surveillance by duplex ultrasound.