When and How Should We Revascularize Patients With Atherosclerotic Renal Artery Stenosis?

• Published in: JACC. Cardiovascular interventions Vol. 12; no. 6; pp. 505 - 517
• Main Authors: Prince, Marloe, Tafur, Jose D., White, Christopher J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 25.03.2019
• Subjects: Atherosclerosis - diagnostic imaging; Atherosclerosis - epidemiology; Atherosclerosis - physiopathology; Atherosclerosis - therapy; Clinical Decision-Making; Endovascular Procedures - adverse effects; Endovascular Procedures - instrumentation; Hemodynamics; Humans; Patient Selection; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - epidemiology; Renal Artery Obstruction - physiopathology; Renal Artery Obstruction - therapy; renal artery stenosis; Renal Circulation; renovascular hypertension; Risk Factors; Severity of Illness Index; stent; Stents; Treatment Outcome; Vascular Patency; stent; CHF; RCT; HTN; GDMT; RAS; RFFR; BMS; ISR; IVUS; renovascular hypertension; RFC; AUC; ACS; CTA; PSV; renal artery stenosis; EPD; FMD; ARAS; CKD; HSG; MRA
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2018.10.023

Atherosclerotic renal artery stenosis is the leading cause of secondary hypertension and may lead to resistant (refractory) hypertension, progressive decline in renal function, and cardiac destabilization syndromes (pulmonary edema, recurrent heart failure, or acute coronary syndromes) despite guideline-directed medical therapy. Although randomized controlled trials comparing medical therapy with medical therapy and renal artery stenting have failed to show a benefit for renal artery stenting, according to comparative effectiveness reviews by the Agency for Healthcare Research and Quality, the trials may not have enrolled patients with the most severe atherosclerotic renal artery stenosis, who would be more likely to benefit from renal stenting. Because of limitations of conventional angiography, it is critical that the hemodynamic severity of moderately severe (50% to 70%) atherosclerotic renal artery stenosis lesions be confirmed on hemodynamic measurement. The authors review techniques to optimize patient selection, to minimize procedural complications, and to facilitate durable patency of renal stenting. The authors also review the current American College of Cardiology and American Heart Association guidelines and the Society for Cardiovascular Angiography and Interventions appropriate use criteria as they relate to renal stenting. [Display omitted]