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Stenting atherosclerotic renal arteries: time to be less aggressive

James F Simon1

  • 1Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA. simonj2@ccf.org

Cleveland Clinic Journal of Medicine
|March 5, 2010
PubMed

Insights

Percutaneous intervention for renal artery stenosis shows high technical success but limited blood pressure benefits. Better methods are needed to predict patient benefit and prevent complications like atheroembolism.

Area of Science:

  • Cardiovascular medicine
  • Interventional nephrology
  • Medical device technology

Background:

  • Percutaneous intervention (PI) is increasingly used for atherosclerotic renal artery stenosis (ARAS).
  • Stent use has improved technical success rates for PI in ARAS.
  • Incidental discovery of ARAS during other angiographic procedures is common.

Purpose of the Study:

  • To evaluate the efficacy of PI for atherosclerotic renal artery stenosis.
  • To identify predictors of patient benefit from PI.
  • To explore methods for preventing adverse events, including atheroembolism.

Main Methods:

  • Review of randomized trials comparing PI to medical management for ARAS.
  • Analysis of factors influencing blood pressure control and renal function outcomes.
  • Assessment of complication rates, focusing on atheroembolism.

Main Results:

  • Randomized trials show PI offers minimal benefit in controlling blood pressure in ARAS patients.
  • The procedure may pose risks to renal function, potentially harming as many patients as it helps.
  • Current methods lack sufficient predictive power for identifying patients who will benefit from PI.

Conclusions:

  • Despite technical success, PI for ARAS has questionable clinical utility regarding blood pressure control.
  • Risk of renal function deterioration necessitates careful patient selection and risk stratification.
  • Further research is crucial for developing predictive models and preventative strategies for PI-related complications.

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