Approach to atherosclerotic renovascular disease: 2016

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Interventional Cardiology

Background:

• Atherosclerotic renal artery stenosis (ARAS) presents a management challenge, particularly in hypertensive patients or those with renal impairment.
• Current guidelines, influenced by major trials like the Angioplasty and Stenting for Renal Atherosclerotic Lesions (ASIL) and Cardiovascular Outcomes for Renal Artery Lesions (CORAL) trials, favor optimal medical management over revascularization.
• The dilemma persists regarding the optimal treatment strategy for ARAS.

Purpose of the Study:

• To critically evaluate the limitations and implications of contemporary clinical trials on ARAS management.
• To present a structured approach for managing patients with ARAS.
• To formulate clear recommendations for the clinical practice of ARAS treatment.

Main Methods:

• Review and critical analysis of existing clinical trial data (ASIL, CORAL).
• Discussion of the limitations inherent in current research methodologies for ARAS.
• Synthesis of evidence to propose a practical management strategy.

Main Results:

• Major clinical trials suggest endovascular intervention offers limited benefit over optimal medical management for most ARAS patients.
• Limitations in trial design and patient selection may impact the generalizability of findings.
• Optimal medical management remains the cornerstone of ARAS care.

Conclusions:

• Endovascular intervention for ARAS should be carefully considered, with a strong emphasis on optimal medical therapy.
• Further research is needed to identify patient subgroups who may benefit from revascularization.
• Clearer guidelines and individualized treatment plans are essential for managing ARAS effectively.