title: Update on intervention versus medical therapy for atherosclerotic renal artery stenosis.
abstract: Atherosclerotic renal artery stenosis is known to be one of the most common causes of secondary hypertension, and early nonrandomized studies suggested that renal artery stenting (RASt) improved outcomes. The vascular community embraced this less invasive treatment alternative to surgery, and RASt increased in popularity during the late 1990s. However, recent randomized studies have failed to show a benefit regarding blood pressure or renal function when RASt was compared with best medical therapy, creating significant concerns about procedural efficacy. In the wake of these randomized trial results, hypertension and renal disease experts along with vascular interventional specialists now struggle with how to best manage atherosclerotic renal artery stenosis. This review objectively analyzes the current literature and highlights each trial's design weaknesses and strengths. We have provided our recommendations for contemporary treatment guidelines based on our interpretation of the available empirical data.
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa. Electronic address: amousa@hsc.wvu.edu.
authors.forename: Albeir Y
authors.initials: AY
authors.lastname: Mousa
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bozzay
authors.affiliation: CAMC Health Education and Research Institute, Charleston, WVa.
authors.forename: Mike
authors.initials: M
authors.lastname: Broce
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Mark
authors.initials: M
authors.lastname: Bates
mesh_terms: D050197:Atherosclerosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018450:Disease Progression; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality / Q000592:standards; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome