Revascularization of renal artery stenosis - state of the art

Atherosclerotic renal artery stenoses (aRAS) are often associated with an aorto-iliac type of peripheral occlusive artery disease and may result in deterioration of blood pressure control, chronic kidney disease and myocardial dysfunction. Stenting of aRAS has almost replaced surgical revascularisation. However, the benefit of endovascular treatment of aRAS was challenged by the results of the STAR and ASTRAL trials demonstrating similar outcomes for revascularisation and conservative treatment. Due to severe limitations in trial design, the study results can only be applied to a small proportion of the affected patient population. A clinical benefit of renal stenting can only be expected if the indication for endovascular procedure was correct, in particular if the hemodynamic relevance of the lesion was verifiedby non-invasive (duplex) or invasive (pressure gradient) methods. The known predictors (pulse pressure >50±10mmHg, high diastolic blood pressure, elevated BNP levels, renal insufficiency) for clinical success are often not sufficiently implemented in the decision-making process. Unquestioned by international guidelines is the indication for revascularisation of aRAS of a single functioning kidneys, severe bilateral lesions, resistant hypertension, worsening of renal function, and in each kind of severe RAS of non-atherosclerotic nature. © Georg Thieme Verlag KG. Stuttgart · New York.