Percutaneous intervention for renovascular disease: rationale and patient selection.
OBJECTIVE
The anatomic diagnosis of renovascular disease is increasing in frequency due to the advent of sophisticated non-invasive imaging modalities such as MRA (Magnetic Resonance Angiography) and renal angiography at the time of cardiac catheterization. Despite this fact, the investigation and appropriate management of renovascular disease has remained a controversial topic. This review addresses the clinical syndromes associated with renal artery stenosis (RAS) and the published data guiding appropriate patient selection for revascularization.


RESULTS
There is a growing literature in support of renal revascularization as an aid in improving anti-hypertensive control, preserving renal function, and easing the management of congestive heart failure. Meanwhile, technological advances have allowed intervention in an expanding pool of eligible patients. One such technology is the atheroembolic protection device, which may soon allow renal salvage in patients with significant baseline renal impairment that were previously denied intervention for fear of worsening renal function.


CONCLUSIONS
The data reviewed herein helps to identify patients that will benefit from renal revascularization. Large-scale, randomized data further defining the role of renal revascularization and optimal patient selection is still needed.
Fernando
Dharsh
D
Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Garasic
Joseph
J
D015906:Angioplasty, Balloon, Coronary / Q000592:standards; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000628:therapy; D007668:Kidney / Q000098:blood supply; D018810:Magnetic Resonance Angiography / Q000592:standards; D018579:Patient Selection; D011654:Pulmonary Edema / Q000209:etiology; D012077:Renal Artery / Q000002:abnormalities / Q000473:pathology*; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D015792:Retinal Dysplasia / Q000175:diagnosis / Q000628:therapy; D014652:Vascular Diseases / Q000175:diagnosis / Q000628:therapy*