Primary stenting for atherosclerotic renal artery stenosis.
BACKGROUND
Endovascular treatment for atherosclerotic renal artery stenosis (ARAS) was first performed >30 years ago and its use has increased rapidly since then. However, only recently have large randomized trials rigorously evaluated its clinical benefit.


METHODS
We systematically reviewed the controlled studies on primary stenting for atherosclerotic renal artery stenosis. Studies were included if they compared the outcome of stenting with other treatments, or the outcome associated with different stent characteristics or stenting methods.


RESULTS
Stenting is preferred over angioplasty alone and over surgery when revascularization is indicated for ostial ARAS, except in cases of coexistent aortic disease indicating surgery. Randomized controlled trials showed no significant benefit and substantial risk of renal artery stenting over medication alone in patients with atherosclerotic ARAS without a compelling indication. Improvements in the procedure, such as with distal embolic protection devices and coated stents, are not associated with better clinical outcomes after stent placement for ARAS.


CONCLUSIONS
Recent evidence shows that impaired renal function associated with ARAS is more stable over time than previously observed. Optimal medical treatment should be the preferred option for most patients with ARAS. Only low-level evidence supports compelling indications for revascularization in ARAS, including rapidly progressive hypertension or renal failure and flash pulmonary edema.
Steichen
Olivier
O
Assistance Publique-Hôpitaux de Paris, Centre d'Investigations Cliniques, Hôpital Européen Georges Pompidou, Université Paris Descartes, Faculté de Médecine, Paris, France.
Amar
Laurence
L
Plouin
Pierre-François
PF
D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D050197:Atherosclerosis / Q000150:complications / Q000628:therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D012078:Renal Artery Obstruction / Q000209:etiology / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D002317:Cardiovascular Agents