Treatment of atherosclerotic renal artery stenosis

Abstract

The increasing prevalence of atherosclerotic renal artery stenosis (ARAS) has prompted in recent years a more aggressive treatment of this condition for reducing BP and for preserving the jeopardized renal function. Percutaneous transluminal renal angioplasty (PTRA), alone or in conjunction with stent implantation, may be useful for both these goals. However, despite the methodological improvements that make this procedure much safer than surgery, caution must be applied before PTRA is extended to all patients with ARAS. Indeed, PTRA is associated with a 23% rate of major/minor complications and with a 20% rate of restenosis, even in arteries implanted with stent. Moreover the cure rate of hypertension achievable with PTRA is, at best, around 10%, with a 40% rate of improvements. Even for rescuing the ischemic kidney, PTRA/stent implantation are not always effective; only 35% of patients with ARAS have some improvement in renal function. These data indicate that there is an urgent need of rigorous criteria for selecting among the many patients with ARAS those who may actually benefit from the dilation procedure.