What does Renal Cell Carcinoma (RCC) with stents in place mean?

Understanding RCC and Renal Stents

RCC refers to Renal Cell Carcinoma, a type of kidney cancer, while stents in place indicates the presence of metal mesh tubes inserted into renal arteries to maintain blood flow in patients with renal artery stenosis.

Renal Cell Carcinoma (RCC)

• RCC is the most common type of kidney cancer, accounting for approximately 70-85% of all kidney cancers 1
• It encompasses several histological subtypes, with clear cell RCC being the most prevalent (70-85% of cases), followed by papillary RCC (7-15%) and chromophobe RCC (5-10%) 1, 2
• RCC is staged according to the TNM classification system, which considers tumor size, extension beyond the kidney, lymph node involvement, and presence of metastases 1, 3
• The 5-year survival rates vary significantly by stage: approximately 95% for stage I, 88% for stage II, 59% for stage III, and 20% for stage IV 1, 3

Renal Artery Stents

• Renal artery stents are metal mesh tubes placed in narrowed renal arteries to maintain blood flow in patients with renal artery stenosis (RAS) 1
• Indications for renal artery stent placement include:
  • Angioplasty failure due to elastic recoil or flow-limiting dissection 1
  • Restenosis after initially successful percutaneous transluminal renal angioplasty (PTRA) 1
  • Primary stenting without initial balloon dilation 1
• Stent placement has shown high technical success rates (96-99%) in treating renovascular hypertension 4, 5
• Clinical benefits include improved blood pressure control and stabilization or improvement of renal function in approximately 69-77% of patients 6, 5

Clinical Implications of RCC with Stents in Place

• When a patient has both RCC and renal artery stents, this indicates:
  • The presence of kidney cancer (RCC) 1
  • A history of renal artery stenosis requiring intervention 1
  • Potential complicating factors for surgical management of the RCC 1
• The presence of stents may influence the surgical approach for RCC treatment, particularly if radical nephrectomy is considered 1
• Regular monitoring is essential for both:
  • RCC progression using appropriate imaging 1
  • Stent patency, as in-stent restenosis can occur in approximately 12-19% of cases 4, 6, 7

Monitoring Considerations

• Duplex ultrasound is commonly used for non-invasive assessment of renal artery stent patency 7
• Different velocity criteria should be used when evaluating stented versus non-stented renal arteries:
  • For stented arteries, peak systolic velocity ≥395 cm/s or renal/aortic velocity ratio ≥5.1 indicates significant in-stent restenosis 7
• Patients with both conditions require careful monitoring of:
  • Renal function through serum creatinine measurements 6, 8
  • Blood pressure control 4, 6
  • Cancer progression through appropriate imaging studies 1

Potential Complications

• Renal artery stent placement can lead to complications in approximately 8.4% of cases, including:
  • Renal infarction (2.8%)
  • Permanently increased serum creatinine levels (5.6%)
  • Need for hemodialysis (2.8%)
  • Requirement for blood transfusion (2.2%) 8
• The presence of stents may complicate surgical interventions for RCC, potentially influencing the choice between partial and radical nephrectomy 1