Controversies in the management of the renal artery stenosis
Khalil Kanjwal2013, Cardiology Journal
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Abstract
Optimal management of renal artery stenosis has continued to remain elusive. The previous non randomized studies and registry data suggested a benefit of renal artery stenting. However, the recently completed randomized studies comparing renal stenting to medical management failed to show any benefit. These studies had some flaws in their design and methodology. In an appropriately selected patient population renal artery stenting may have a role. In addition, there might be some role of adjunctive therapies like antiplatelet medications and embolic protection. This review summarizes the current literature on this controversial topic.
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Background and Aims Renal artery stenosis (RAS) is present from 1% to 5% in people affected by arterial hypertension and it is often associated with peripheral artery disease and coronary artery disease; as the matter of fact, it is commonly found in people undergoing cardiac catheterization (18-20%) or angiography for aorto-iliac and lower extremities diseases. The major cause of renal artery stenosis is an atherosclerotic lesion localized in the proximal segment or to the ostium. Clinical presentations are renovascular hypertension and ischemic nephropathy. The aim of the study is to define either endovascular treatment gives a significant benefit on renal function and blood pressure control, when associated to medical therapy. Method This is a retrospective study focused on patients who underwent renal artery angioplasty and stenting in the last ten years, from November 2011 to April 2021 in the Nephrology Department, at Sant'Andrea Hospital, La Spezia (Italy). The primary ou...
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The pathophysiology of atherosclerotic renal artery stenosis (RAS) includes activation of the renin-angiotensin-aldosterone axis with resultant renovascular hypertension. Renal artery stenting has emerged as the primary revascularization strategy in most patients with hemodynamically significant atherosclerotic RAS. Despite the frequency with which hemodynamically significant RAS is observed and high rates of technical success of renal artery stenting, there remains considerable debate among experts regarding the role of medical therapy versus revascularization for renovascular hypertension. Modern, prospective, multicenter registries continue to demonstrate improvement in systolic and diastolic blood pressure with excellent safety profiles in patients with RAS. Modern randomized, controlled clinical trials of optimal medical therapy versus renal stenting particularly designed to demonstrate preservation in renal function after renal artery stenting have demonstrated limited benefit...
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International Journal of Angiology, 2007
ObJeCTIve: To study the response of systolic and diastolic blood pressure (BP) and renal function after renal artery stenting at three months, six months, one year and last follow-up. MeTHODS: Patients with significant renal artery stenosis who underwent angioplasty with stenting from January 1999 to September 2006 were analyzed. The BP and serum creatinine levels were recorded at baseline, three months, six months, one year and at last follow-up. Generalized estimating equations were applied to analyze the changes in blood pressure and serum creatinine over time. ReSulTS: There were 32 patients-21 Chinese, six Malay and five Indian. The male to female ratio was 1.3:1. The mean age (± SD) was 69.4±8.8 years. The mean follow-up time was 1.8±1.6 years (range 0.5 to six years). When compared with the baseline BP, there was significant improvement at three months, six months, one year and at last follow-up. In the diabetes mellitus (DM) group, there was deterioration in serum creatinine. In the non-DM group, there was stabilization of serum creatinine with improvement at one year. COnCluSIOn: Significant improvement in BP occurs in renal artery stenosis patients after stenting. In patients without DM, renal function remains stable or improves. However, in DM patients, especially those with proteinuria, there is deterioration in renal function.
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