Does Renal Artery Stenting Prevent Clinical Events?

Textor, Stephen C.; Misra, Sanjay

doi:10.2215/cjn.04640416

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…However, these trials have been broadly criticized because of criteria used for patients’ selection and, as suggested by many observational studies, timely identification and treatment of ARAS might modify the natural history of disease at least in some of these patients. The challenge is therefore to define which patients with ARAS will potentially benefit from renal artery revascularization in terms of renal and cardiovascular protection [25] and specifically designed observational investigations could provide insight in specific groups of patients. The present study has been the first designed specifically to investigate the effects of renal artery stenting in patients with resistant hypertension and hemodynamically significant (>70%) ARAS free of advanced renal failure and overt proteinuria.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Renal and Cardiac Outcomes after Stenting in Patients with Resistant Hypertension and Atherosclerotic Renal Artery Stenosis

Catena

Colussi

Brosolo

et al. 2017

Kidney Blood Press Res

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Background/Aims: Atherosclerotic renal artery stenosis (ARAS) is frequently detected in patients with resistant hypertension (RHTN), but the evidence supporting the utility of renal revascularization in these patients is limited. This prospective, observational study investigates the outcomes of renal stenting in patients with RHTN and hemodynamically significant ARAS. Methods: Fifty-four patients with RHTN were selected because of angiographic evidence of ARAS >70% and were followed for 4 years after renal stenting. Renal function and echocardiographic variables were assessed at baseline and during follow-up. Results: Blood pressure decreased rapidly after renal stenting and was normalized in 67% of patients at six months, with significant reduction in the number of antihypertensive drugs. Creatinine clearance increased in 39% of patients, decreased in 52%, and remained stable in the remaining 9%, with an average value that had a nonsignificant decrease during follow-up. Urinary albumin excretion did not change throughout the study. After 4 years, left ventricular (LV) wall thickness and concentric geometry decreased significantly and variables of LV diastolic function improved. Conclusion: In patients with RHTN, stenting of hemodynamically significant ARAS decreases blood pressure, preserves renal function in a substantial proportion of patients, and improves LV structure and function, suggesting the opportunity for timely identification of ARAS in these patients.

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Section: Discussionmentioning

confidence: 99%

Long-Term Renal and Cardiac Outcomes after Stenting in Patients with Resistant Hypertension and Atherosclerotic Renal Artery Stenosis

Catena

Colussi

Brosolo

et al. 2017

Kidney Blood Press Res

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show abstract

“…The limitations of these trials have been substantial, however, particularly as many severe cases of rapidly progressive renal insufficiency, intractable hypertension, and/or episodic pulmonary edema have not been enrolled 26,45 . Hence, these trials suffer from underrepresentation of high-risk disease, as has been emphasized from registry 25,41 and observational reports 46 .…”

Section: Diagnosis: Clinical Manifestationsmentioning

confidence: 99%

Renal Arterial Disease and Hypertension

Textor

2017

Medical Clinics of North America

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Renal Artery Stenosis in Patients with Resistant Hypertension: Stent It or Not?

et al. 2017

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After three large neutral trials in which renal artery revascularization failed to reduce cardiovascular and renal morbidity and mortality, renal artery stenting became a therapeutic taboo. However, this is probably unjustified as these trials have important limitations and excluded patients most likely to benefit from revascularization. In particular, patients with severe hypertension were often excluded and resistant hypertension was either poorly described or not conform to the current definition. Effective pharmacological combination treatment can control blood pressure in most patients with renovascular hypertension. However, it may also induce further renal hypoperfusion and thus accelerate progressive loss of renal tissue. Furthermore, case reports of patients with resistant hypertension showing substantial blood pressure improvement after successful revascularization are published over again. To identify those patients who would definitely respond to renal artery stenting, properly designed randomized clinical trials are definitely needed.

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Does Renal Artery Stenting Prevent Clinical Events?

Cited by 5 publications

References 25 publications

Long-Term Renal and Cardiac Outcomes after Stenting in Patients with Resistant Hypertension and Atherosclerotic Renal Artery Stenosis

Long-Term Renal and Cardiac Outcomes after Stenting in Patients with Resistant Hypertension and Atherosclerotic Renal Artery Stenosis

Renal Arterial Disease and Hypertension

Renal Artery Stenosis in Patients with Resistant Hypertension: Stent It or Not?

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