[Percutaneous revascularization of renal artery stenosis. Balloon angioplasty vs. stent implantation].
Renal artery stenosis (RAS) is the most common cause of secondary hypertension, with a prevalence of about 1% in the general population of people with hypertension. Severe arterial stenosis may also lead to impairment of excretory renal function. In experienced hands renal artery revascularization with or without stent implantation may be a safe and effective treatment in patients with sustained hypertension resistant to intensive antihypertensive treatment. Conventional balloon angioplasty of non-ostial RAS caused by fibromuscular dysplasia with a high technical and functional success rate may be the treatment of choice. However, there is continuous discussion concerning the utility of balloon angioplasty and renal stenting, respectively, in patients with atherosclerotic disease. At the time being, there are 3 randomized European trials ongoing to analyze the benefit of medical treatment versus percutaneous intervention. Several prospective studies dealing with renal artery stenting in ostial RAS found that the implantation of endoprostheses leads to much better morphologic longterm results as compared to those of balloon angioplasty alone and may be a safe and effective alternative to surgery. In addition, the functional results suggest that stent implantation in patients with mild or severe renal dysfunction may slow progression of renal failure and, thus delay the need for renal replacement therapy. It is to note that renal artery stenting does not impede any further surgical intervention. However, prior to any interventional treatment the indication of an eventual catheter procedure in patients with RAS should be discussed between experienced nephrologists and interventionalists based on clinical, functional and duplexsonographic data.
Blum
U
U
Insitut für Medizinische Radiologie, Universitätsspital Zürich.
Hauer
M
M
Krumme
B
B
D000800:Angioplasty, Balloon; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology*; D007674:Kidney Diseases / Q000175:diagnosis; D007677:Kidney Function Tests; D012078:Renal Artery Obstruction / Q000150:complications* / Q000601:surgery; D015607:Stents