Recent advances in renal artery stenting

Renal artery stenosis (RAS) is frequent and increasingly recognized thanks to technical improvements in duplex ultrasound, magnetic resonance angiography, computed tomography (CT) scanning, systematic renal angiography during cardiac catheterisation, coronary procedures and particularly in hypertensive or multivascular diseased patients. Renal artery angioplasty and stenting is the first treatment to be proposed for patients suffering from RAS. This procedure is largely performed with very good technical results, good anatomical results, a low complication rate and a good long-term patency. The technique has proven to be beneficial for preserving RF and stabilizing or improving BP in a large number of patients. Nevertheless, deterioration in RF after the procedure in 20-30% of cases may limit the immediate benefits of this technique. Atheroembolism seems to play an important role. Renal angioplasty with protection devices seems a promising technique that might become the standard of care in the future. Even so, some problems remain: the cost of the technique; the best protection device needs to be determined; protection devices specifically designed for the renal arteries are needed; indications have to be specified. Larger, randomised studies are awaited to confirm the usefulness of the technique.