Incidental Atherosclerotic Renal Artery Stenosis Diagnosed at Cardiac Catheterization: No Difference in Kidney Function with or without Stenting

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

“…When elderly patients (mean age 73.2Ϯ8.1 years, median eGFR 51.2 mL/min/1.73 m 2 ) undergoing nonemergent coronary angiography were angiographically screened for RAS, and those with Ͼ50% RAS referred for nuclear renography, about half had evidence of reduced perfusion to 1 kidney. 174,175 Of these, 13% were discordant with the angiographic lesion, and only 9% had positive captopril renograms. A positive captopril renogram was associated with severe (Ͼ70%) unilateral RAS.…”

“…174 The importance of "incidental" RAS identified at nonemergent cardiac angiography has been examined. 175 Patients with Ն50% stenosis underwent nuclear renography and were managed with or without stenting as recommended by their nephrologist and/or cardiologist. Of the 140 patients, 67 (48%) were stented, mostly for "preservation of kidney function" (70.1%) and/or resistant hypertension (53.7%).…”

“…Although there was no evidence of either harm or benefit of stenting, the significance of these lesions and how they are best managed remains unclear. 175 The ASTRAL (Angioplasty and Stenting for Renal Artery Lesions) trial of 806 patients found substantial risks, but no evidence of meaningful clinical benefit from revascularization in patients with atherosclerotic RAS. 669 Additional information should come from the ongoing CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) trial to determine whether stenting atherosclerotic RAS in patients reduces cardiovascular and/or renal events (www.coralclinicaltrial.org).…”

Incidental Atherosclerotic Renal Artery Stenosis in Patients Undergoing Elective Coronary Angiography: Are These Lesions Significant?

“…Patients enrolled in this study partially, but did not entirely, overlap with those enrolled in two other recently published reports examining iARAS [2, 8]. Recruitment for the Buller et al [2] study ended in May 2002, and in the Zalunardo et al [8] study in December 2005, whereas the current study enrolled until February 2006.…”

“…This study is a retrospective analysis of this prospectively assembled cohort. A second planned study using an overlapping cohort of participants has been published which describes changes in eGFR among those with and without endovascular stents [8]. …”