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To Stent or Not to Stent? Update on Revascularization for Atherosclerotic Renovascular Disease

  • Device-Based Approaches for Hypertension (M Schlaich, Section Editor)
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Abstract

Renal artery stenosis (RAS) is increasingly encountered in clinical practice. The two most common etiologies are fibromuscular dysplasia (FMD) and atherosclerotic renal artery disease (ARAS), with the latter accounting for the vast majority of cases. Significant RAS activates the renin–angiotensin–aldosterone system and is associated with three major clinical syndromes: ischemic nephropathy, hypertension, and destabilizing cardiac syndromes. Over the past two decades, advancements in diagnostic and interventional techniques have led to improved detection and the widespread use of endovascular renal artery revascularization strategies in the management of ARAS. However, renal artery stenting for ARAS remains controversial. Although several studies have demonstrated some benefit with renal artery revascularization, this has not been to the extent anticipated or predicted. Moreover, these trials have significant flaws in their study design and are hampered with inherent bias which make their interpretation challenging. In this review, we evaluate the existing body of evidence and offer an approach to the management of patients with ARAS in light of the current literature. From the data provided, identification of subgroup of patients, namely, those with a hemodynamically significant RAS in the context of progressive renal insufficiency and/or deteriorating arterial hypertension, seems possible and may derive clinical benefit from ARAS stent revascularization. Appropriate patient selection is therefore the key and more robust studies are required.

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Authors and Affiliations

  1. Department Cardiology and Angiology II, Universitaets-Herzzentrum Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany

    Elias Noory, Kaji Sritharan & Thomas Zeller

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  1. Elias Noory
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  2. Kaji Sritharan
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Correspondence to Elias Noory.

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This article is part of the Topical Collection on Device-Based Approaches for Hypertension

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Noory, E., Sritharan, K. & Zeller, T. To Stent or Not to Stent? Update on Revascularization for Atherosclerotic Renovascular Disease. Curr Hypertens Rep 18, 45 (2016). https://doi.org/10.1007/s11906-016-0655-4

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