title: [Management of atherosclerotic renal-artery stenosis in 2016].
abstract: Endovascular revascularization as treatment of atherosclerotic renal-artery stenosis (aRAS) is controversial since 3 large and multicentric randomised trials (CORAL, ASTRAL, STAR) failed to prove the superiority of percutaneous transluminal renal-artery stenting (PTRAS) over medical treatment only (MT). However, considering the multiple bias of these trials, among which questionable inclusion criterias, these results must be extrapolated in clinical practice with caution. New pathophysiological data have been helping to understand why restoring blood flow does not necessarily lead to kidney function improvement. Today, the diagnostic approach must in one hand confirm the artery stenosis and on the other hand assess its severity and impact on the kidney. Therapeutic options still lie on the American guidelines published in 2006, since no study data can be reasonably used in everyday practice. However, particular sub-groups of patients who could benefit from revascularisation have been identified through recent cohort studies. Further prospective studies are needed in order to confirm the superiority of PTRAS in these populations. Meanwhile, multidisciplinary approach should be promoted, in order to provide the best treatment for each patient.
authors.affiliation: Service de néphrologie, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France. Electronic address: tfournier12@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fournier
authors.affiliation: Service de néphrologie, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Pôle IMER, site Lacassagne, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Sens
authors.affiliation: Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Service d'imagerie vasculaire et urinaire, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouvière
authors.affiliation: Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Service de chirurgie vasculaire, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Millon
authors.affiliation: Service de néphrologie, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; OPeRa, Carmen, université Lyon 1, 11, avenue Jean-Capelle, 69621 Villeurbanne cedex, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Juillard
mesh_terms: D017130:Angioplasty; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000628:therapy*; D015607:Stents
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: Angioplastie; Angioplasty; Hypertension; Hypertension artérielle; Maladie rénale chronique; Renal insufficiency; Renal-artery obstruction; Sténose athéromateuse d’artère rénale