Percutaneous endovascular therapy of renal artery stenosis: technical and clinical developments in the past decade

Renal artery stenosis may initiate or exacerbate arterial hypertension and/or renal insufficiency. During the last decade, technical improvements of diagnostic and interventional endovascular tools have led to more widespread use of endoluminal renal artery revascularization and broader indications for this type of therapy. Since the first renal artery angioplasties performed by Felix Mahler and Andreas Gruntzig in 1978, numerous single-center studies have documented the benefits of percutaneous renal revascularization. In the early 1990s, stent implantation was added to the interventionist's armamentarium for treating renal artery stenosis due to atherosclerosis or fibromuscular dysplasia. The meta-analysis of 3 randomized studies comparing balloon angioplasty with best medical therapy found intervention to be beneficial for blood pressure control but not for preservation of renal function. Despite the absence of randomized studies, there is mounting evidence that stenting of hemodynamically relevant atherosclerotic renal artery stenosis has a positive impact on blood pressure control and renal function. This article summarizes the technical improvements in these endovascular tools during the last decade and gives an overview concerning their clinical impact on renal artery revascularization.