Atherosclerotic Peripheral Vascular Disease Symposium II

Utilization of excimer laser debulking for critical lesions unsuitable for standard renal angioplasty

“…The bulk of obstructive atherosclerotic plaque can impose a considerable barrier to safe delivery of protection systems, balloons and stents into the renal artery. Tight ostial or proximal stenoses, with marked eccentricity of the plaque and/or presence of accompanying thrombus, render a target lesion prone to the risk of distal embolization of atheromatous debris from equipment manipulations [15]. This raises the potential for a modified revascularization approach beginning with plaque debulking for facilitation of delivery of the standard equipment.…”

Endovascular Management of Atherosclerotic Renal Artery Stenosis: Post-Cardiovascular Outcomes in Renal Atherosclerotic Lesions Era Winner or False Alarm?

“…Resistant hypertension is defined as failure to reduce BP values <140 mmHg, after an aggressive medical treatment consisting of ≥3 drugs (ideally including a diuretic drug) [15,16]. Recently, a functional classification of RAS in association with hypertension has been proposed [17]:…”

Atherosclerotic Renovascular Hypertension : Lessons from Recent Clinical Studies

“…According to a clinical classification of atherosclerotic renal artery stenosis with guidelines for vascular intervention of surveillance published in 2008 by the Atherosclerotic Peripheral Vascular Symposium23), additional recommendations favoring medical therapy were as follows: very advanced age and/or limited life expectancy, extensive co-morbidities that make revascularization too risky, high risk for or previous experience with atheroembolic disease, and other concomitant renal parenchymal diseases that cause progressive renal dysfunction (e.g., interstitial nephritis, diabetic nephropathy)23). They also recommended factors favoring medical therapy and intervention as follows: progressive decline in GFR during treatment of systemic hypertension, failure to achieve adequate blood pressure control with optimal medical therapy (medical failure), rapid or recurrent decline in the GFR in association with a reduction in systemic pressure, decline in the GFR during therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and recurrent congestive heart failure in a patient in whom the adequacy of left ventricular function does not provide an explanation23). The best evidence supporting intervention is for bilateral stenosis with "flash" pulmonary edema, but the evidence is from retrospective studies24-26).…”