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Cited by 16Renal and Vascular PathologiesPeripheral Artery Disease ManagementCerebrovascular and Carotid Artery Diseases

Renal Artery Stenosis: Optimal Therapy and Indications for Revascularization

Patel, Sandeep M., Li, Jun, Parikh, Sahil A.·2015·Current Cardiology Reports
DOI 10.1007/s11886-015-0623-7
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Abstract

Atherosclerotic renal artery stenosis (ARAS) is associated with increased cardiovascular risk and overall mortality. Manifestations of ARAS include resistant or malignant hypertension, progressive deterioration of renal function, and cardiac dysfunction syndromes of flash pulmonary edema and angina. Diagnosis rests upon non-invasive studies such as duplex ultrasonography and is confirmed using invasive renal arteriography. Regardless of the severity of ARAS, management of this entity has been a topic of contentious debate. For over two decades, the use of percutaneous revascularization to treat ARAS has been studied with various clinical trials. Though case series seem to demonstrate favorable clinical response to revascularization, the overwhelming majority of randomized clinical trials have not mirrored a robust outcome. In these trials, poor correlation is noted between the reduction of stenosis and the improvement of renovascular hypertension and glomerular filtration rate, and decrease in cardiovascular outcomes and mortality. With dichotomizing results, the explanation for these discrepant findings has been attributed to improper trial design and inappropriate patient selection. An overview of the treatment options available will be provided, with a focus on the methodology and design of clinical trials investigating the efficacy of percutaneous revascularization. Emphasis is placed on appropriate patient selection criteria, which may necessitate the use of hemodynamic lesion assessment and clinical correlation based on individualized care. When clinical equipoise exists between optimal medical therapy and revascularization, the current paradigm supports ongoing medical therapy as the treatment of choice. However, renal artery stenting remains a viable therapeutic option for those who continue to have clinical syndromes consistent with renal hypoperfusion while adequately treated with optimal medical therapy. Despite observational studies suggesting clinical benefit for this specific patient population, there remains a paucity of randomized clinical trial data. Further trials targeting the patients who are inadequately treated with optimal medical therapy need to be undertaken to confirm the efficacy of revascularization.

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  • Moderate degrees of renovascular hypertension most often can be managed with medical therapy, particularly with the use of agents that block the renin-angiotensin system (ACE inhibitors/ARBs), as several prospective randomized trials have demonstrated.

    “Moderate degrees of renovascular hypertension most often can be managed with medical therapy, particularly with the use of agents that block the renin-angiotensin system (ACE inhibitors/ARBs), as several prospective randomized trials have demonstrated.309,310”

    From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [309]

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Authors
Patel, S. M., Li, J., & Parikh, S. A.
Affiliations
  • Case Western Reserve University (US)
  • University Hospitals of Cleveland (US)
Corresponding author
Parikh, Sahil A.
ORCID
Venue
Current Cardiology Reports
Publisher
Springer Science and Business Media LLC
Published
2015-08-04
Volume
17
Issue
9
Pages
623-623
ISSN
  • 1523-3782 (ISSN-L)
  • 1534-3170
DOI
10.1007/s11886-015-0623-7
OpenAlex
W2183261695
Cited by
16
References
72
Citations by year
2024: 2 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 5 · 2018: 1 · 2017: 3 · 2016: 1
FWCI
0.30
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Current Cardiology Reports (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
  • Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
Keywords
atherosclerotic renal artery stenosis, percutaneous revascularization, renal artery stenting, renovascular hypertension, resistant hypertension, patient selection, clinical trial design, optimal medical therapy, glomerular filtration rate, cardiovascular outcomes, renal hypoperfusion
MeSH terms
Antihypertensive Agents, Humans, Hypertension, Renovascular, Prognosis, Renal Artery, Renal Artery Obstruction, Risk Factors, Stents, Disease Progression, Patient Selection

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