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Renal artery stenting: patient selection post-CORAL
J Hudson Segrest1, William B Hillegass1,2
1Heart South Cardiovascular Group, Alabaster, Alabama.
Summary
Renal artery stenting (RAS) offers no significant hypertension benefit for moderate cases. Severe hypertension with high-grade stenosis may improve with RAS, guided by factors like renal frame count.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Nephrology
Background:
- Randomized trials (RCTs) indicate renal artery stenting (RAS) provides no significant hypertension control improvement over medical therapy alone in patients with moderate hypertension and intermediate-grade renal artery stenoses.
- Observational studies suggest potential blood pressure benefits of RAS in patients with severe hypertension and high-grade stenoses on multiple medications.
Discussion:
- Angiographic assessment of renal artery stenosis severity poorly correlates with functional measures of flow impairment.
- Renal frame count emerges as a potential simple measure of flow impairment, predicting a positive blood pressure response to RAS.
Key Insights:
- RAS is not universally beneficial for hypertension control; patient selection is crucial.
- Severe hypertension and high-grade stenosis are key indicators for potential RAS benefit.
- Renal frame count may refine patient selection for RAS by assessing flow impairment.
Outlook:
- Further studies are needed to validate renal frame count (>30) and clinical factors for guiding RAS patient selection.
- Optimizing RAS patient selection can improve therapeutic outcomes in resistant hypertension.
- Integrating functional flow assessment may enhance the efficacy of interventional strategies for renal artery stenosis.
