title: Renal artery stenosis: Up-date on diagnosis and treatment.
abstract: Significant renal artery stenosis (RAS) can cause or result in deterioration of arterial hypertension and may promote the development of renal insufficiency. The activation of the renin-angiotensin-aldosterone system results in structural heart disease and may impact patient survival. Technical improvements of diagnostic and interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy during the past two decades. Whereas balloon angioplasty is still the method of choice for the treatment of fibromuscular dysplasia, stent implantation is indicated in ostial atherosclerotic RAS. However, none of the so far published or presented randomized controlled trials could prove a beneficial outcome of RAS revascularization compared to medical management. As a result of these negative trials including the largest published trial to date, the ASTRAL trial, referrals to endovascular renal artery revascularization have declined and, moreover, reimbursement of these procedures has become a matter of debate. Crucial for a clinical benefit following revascularization of RAS is proper patient selection, revascularization being only indicated after proof of hemodynamic relevance of RAS. This article summarizes the appropriate diagnostic work-up of patients with suspected RAS, discusses the limitations of the results published so far and their impact on the indication for RAS revascularization.
authors.affiliation: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
authors.affiliation: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Macharzina
authors.affiliation: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Aljoscha
authors.initials: A
authors.lastname: Rastan
authors.affiliation: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beschorner
authors.affiliation: University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Elias
authors.initials: E
authors.lastname: Noory
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D018579:Patient Selection; D011237:Predictive Value of Tests; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
keywords: Renal artery stenosis; angioplasty; hypertension; renal function; stent; structural heart disease