title: Where now in the management of renal artery stenosis? Implications of the ASTRAL and CORAL trials.
abstract: OBJECTIVE
  The neutral findings of Angioplasty and Stenting for Renal Artery Lesions and Cardiovascular Outcomes in Renal Artery Lesions trials have shown that unselected revascularization does not improve outcomes in atherosclerotic renovascular disease (ARVD). This review highlights recent translational, clinical and epidemiological studies and suggests directions for future research.
  
  
  RESULTS
  Imaging studies show that the degree of renal artery stenosis is not the most important determinant of outcome and response to therapies in ARVD. Porcine models have established a better understanding of the microvascular and inflammatory changes that occur in ARVD. Biomarkers of inflammation and cardiovascular dysfunction may be informative but do not yet help assess prognosis or response to treatment. Stem cell therapies show promise in animal models but have yet to translate into clinical practice. Analysis of patient subgroups with high-risk presentations of ARVD has provided new insights into treatment response and may guide future studies.
  
  
  CONCLUSIONS
  It is time to reframe thinking and research in ARVD. We need better ways to identify patients likely to benefit from revascularization and to improve response to treatment in these individuals. Many preclinical studies show promise, but these are often small scale and difficult to replicate. Future work should focus on establishing an international disease registry as a foundation for collaborative research.
authors.affiliation: Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: James
authors.initials: J
authors.lastname: Ritchie
authors.forename: Helen V
authors.initials: HV
authors.lastname: Alderson
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D002986:Clinical Trials as Topic; D004195:Disease Models, Animal; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers