Update on intervention versus medical therapy for atherosclerotic renal artery stenosis

Abstract

Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary hypertension, and early nonrandomized studies suggested that renal artery stenting (RASt) improved outcomes. The vascular community embraced this less invasive treatment alternative to surgery, and RASt increased in popularity during the late 1990s. However, recent randomized studies have failed to show a benefit regarding blood pressure or renal function when RASt was compared with best medical therapy, creating significant concerns about procedural efficacy. In the wake of these randomized trial results, hypertension and renal disease experts along with vascular interventional specialists now struggle with how to best manage atherosclerotic renal artery stenosis. This review objectively analyzes the current literature and highlights each trial’s design weaknesses and strengths. We have provided our recommendations for contemporary treatment guidelines based on our interpretation of the available empirical data.

Efficiency of Percutaneous Stent Angioplasty in Renal Artery Stenosis – 15 Years of Experience at a Single Center

“…CORAL, a recent large randomized clinical trial for RAS, similarly showed a statistically significant improvement in BP as well as a reduction in medical therapy in patients undergoing revascularization [13]. From the 47 studies reviewed by Mousa et al,37 (78.7 %) showed an improvement in BP control after revascularization [14]. Arthurs et al described a decrease in the rate of renal injury and an improvement in blood pressure control, although the latter was limited to 6 months [15].…”

A randomized, multi-center, prospective study comparing best medical treatment versus best medical treatment plus renal artery stenting in patients with hemodynamically relevant atherosclerotic renal artery stenosis (RADAR) – one-year results of a pre-maturely terminated study

“…The reason for the lack of evidence is likely associated with major flaws in the study design and study conduct (e.g. inclusion of patients with stenosis < 50%), which invalidated the results and which are discussed in detail in recent reviews [ 4 , 20 ]. Also, the studies did not evaluate patients who did not respond to BMT and those who were not eligible for inclusion in the study [ 21 ].…”

Renal artery stent in solitary functioning kidneys

“…[ 19 ] The goals of therapy in patients with ARAS are to control BP, to reduce fluid shifts that may cause sudden pulmonary congestion, and to improve or stabilize RF. [ 20 ]…”