Stenting renal artery stenosis: what is the fuss all about?

Renal artery stenosis is the most common cause of secondary hypertension after exclusion of renal parenchymal disease and/or hypertensive nephrosclerosis. Atherosclerotic processes comprise the major contributors to this condition and account for 90% of the disease burden. Usually, the disease comes to light when there has been substantial morbidity resulting from several years of uncontrolled blood pressures and renal failure. Early recognition and intervention is warranted. Interventions include both medical and surgical modalities. Currently, there are several reliable diagnostic procedures to identify renal artery stenosis. However, once the disease process is identified, the management differs quite dramatically based on the patient population, the goals of therapy such as control of hypertension versus amelioration of ischemic nephropathy, availability of interventionists and so on. In this review, we discuss the importance of identifying atherosclerotic renal artery stenosis, the diagnostic modalities available and some of the interventions used to manage this disorder. We emphasize evidence based medicine and recent clinical trials such as the STAR trial.