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Update on the management of atherosclerotic renal artery disease

E R Fenstad1, G C Kane

  • 1Mayo Graduate School of Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.

Minerva Cardioangiologica
|February 10, 2009
PubMed

Insights

Atherosclerosis causing renal artery stenosis may lead to hypertension and heart failure. Treatment involves aggressive blood pressure control and risk factor modification, but revascularization

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Vascular Surgery

Background:

  • Renal artery stenosis (RAS) is often caused by atherosclerosis, typically affecting the renal artery ostium or proximal segment.
  • While often asymptomatic, RAS can be linked to systemic atherosclerosis, hypertension, renal dysfunction, and heart failure.

Purpose of the Study:

  • To summarize the current understanding of atherosclerotic renal artery stenosis (ARAS).
  • To outline current management strategies for ARAS.
  • To highlight the ongoing debate regarding the role of revascularization in ARAS.

Main Methods:

  • Review of existing literature on atherosclerotic renal artery stenosis.
  • Analysis of current clinical guidelines and expert opinions.
  • Consideration of evidence from ongoing clinical trials (e.g., CORAL, ASTRAL).

Main Results:

  • Atherosclerosis is the primary cause of RAS.
  • Management includes aggressive blood pressure control, risk factor modification, and anti-platelet therapy.
  • The benefit of revascularization for ARAS is still under investigation.

Conclusions:

  • Diagnosis of ARAS warrants aggressive medical management.
  • Individualized assessment is crucial for considering revascularization due to unclear benefits.
  • Further evidence from trials like CORAL and ASTRAL is needed to clarify the role of revascularization.

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