Percutaneous Revascularization for Atherosclerotic Renal Artery Stenosis: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Percutaneous revascularization (PR) of atherosclerotic renal artery stenosis (RAS) improves patency in the renovascular disease. However, whether PR is associated with additional clinical benefits in the patients with atherosclerotic RAS remains controversial. We conducted a meta-analysis to evaluate the outcomes of PR versus medication alone for atherosclerotic RAS.

Methods: We compiled an electronic database of prospective, randomized, controlled trials related to the efficacy of PR versus medication for RAS. The standardized mean difference (SMD) or relative risk ratios (RRs) were estimated with 95% confidence intervals (CI) based on an intention-to-treat analysis. We considered the following outcomes: changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), reduction in antihypertension medication, serum creatinine, worsening renal failure, mortality, stroke, and congestive heart failure.

Results: Seven trials with a total of 1916 patients (937 with PR, 979 with medication alone) were analyzed. The changes in SBP/DBP from baseline were similar between the 2 groups (changes in SBP: P = 0.69; changes in DBP: P = 0.15). PR treatment led to a statistically significant decrease in the number of antihypertensive medications compared with medical management alone (SMD -0.18, 95% CI -0.27 to -0.10, P < 0.001). The pooled RR for deteriorating renal function, congestive heart failure, or stroke showed no significant difference.

Conclusion: PR is equally effective to medical management in the treatment of RAS. Therefore, patients with atherosclerotic RAS along with hypertension or chronic kidney disease should receive medical therapy to control blood pressure, but they should not be considered for a renal artery stent.