Management of Atherosclerotic Renal Artery Stenosis: Interventional Versus Medical Therapy

Atherosclerotic renal artery stenosis (RAS) is the most common secondary cause of hypertension, and often results in hypertension that is difficult to control. Atherosclerotic RAS may also result in chronic renal insufficiency, and although controversial, likely leads to end-stage renal failure in a subset of patients. Bilateral RAS, or stenosis to a solitary functioning kidney, has resulted in recurrent episodes of "flash" pulmonary edema and unstable angina pectoris. Despite these serious sequelae of RAS, there remains no consensus on optimal therapy. Invasive therapy (endovascular percutaneous transluminal angioplasty, with or without stent deployment; surgical revascularization) has generated significant interest among interventional physician specialists. However, effective antihypertensive therapy may be a reasonable option in certain scenarios.