Fractional Flow Reserve–Guided Renal Artery Stenting in Renovascular Hypertension

作者：Yuxi Li, Rujie Zheng, Xu Liu, Jingang Zheng, Chengzhi Lu, Fangfang Fan, Fude Zhou, Jianxing Qiu, Zhiyong Lin, Shuduo Zhou, Zhihao Liu, Shengcong Liu, Tieci Yi, Long Zhang, Haoyu Weng, Beining Wang, Yuxi Chang, Hui Zhou, Dengfeng Ma, Zhi Jia, Xiang Li, Renqiang Yang, Dongmei Shi, Hui Chen, Li Xu, Cun Liu, Kazuomi Kario, Yan Zhang, Jianping Li · 发表于：JACC: Cardiovascular Interventions · 年份：2026 · DOI：10.1016/j.jcin.2026.05.019 · 被引用次数：1 · 研究领域：Renal and Vascular Pathologies、Abdominal vascular conditions and treatments、Peripheral Artery Disease Management

BACKGROUND: Whether fractional flow reserve (FFR)-guided revascularization improves outcomes in atherosclerotic renal artery stenosis (ARAS) remains uncertain. OBJECTIVES: This study will evaluate whether the benefit of FFR-guided stenting sustained at 1 year including renal outcomes. METHODS: FAIR pilot is an investigator-initiated, multicentre, open-label trial with blinded endpoint adjudication. Adults with ARAS were randomized 1:1 to FFR-guided vs angiography-guided groups. Stenting was performed in the FFR-guided group when FFR <0.80, and it was performed for all in the angiography-guided group regardless of FFR. The percentage changes in ambulatory daytime mean systolic blood pressure (DMSBP), composite index of antihypertensive medicines (CIAHM), and renal outcomes were analyzed for 1 year. RESULTS: Among all 107 randomized patients, 1-year follow-up was achieved in 50 (93%) in the FFR-guided group and 51 (96%) in the angiography-guided group. At 1 year, DMSBP, CIAHM, and renal outcomes were similar between the groups, while stenting rate was lower with FFR guidance (46% vs 100%, P < 0.01). Patients with FFR <0.80 who underwent stenting experienced the greatest blood pressure reductions (median [IQR] ΔDMSBP: 13 [4, 21] mm Hg at 3 months; 8 [3, 16] mm Hg at 6 months, 7 [0, 16] mm Hg at 12 months; all paired P < 0.05) and sustained declines in CIAHM (2 [0, 5] at 3, 6, and 12 months; all paired P < 0.05). Significant 12-month estimated glomerular filtration rate improveme...