Atherosclerotic renal artery stenosis and revascularization

Abstract

Atherosclerotic renovascular disease is the most common cause of secondary hypertension. The patients with renovascular disease are at increased risk for adverse cardiac outcomes. Recent trials comparing medical therapy alone to medical therapy with stenting are flawed, but lay to rest any existing debate that unselected revascularization is unwarranted; however, revascularization may be appropriate in high-risk populations. Defining an appropriate population for revascularization is an area of ongoing study. Furthermore, delivery of optimal medical therapy in this population is inadequate. This review describes recent developments in renal artery revascularization.

Keywords::

• percutaneous transluminal renal angioplasty
• renal artery stenosis
• renovascular hypertension
• transluminal angioplasty

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Atherosclerotic renal artery stenosis is a common cause of hypertension and declining renal function.

• Atherosclerotic renal artery stenosis is associated with adverse cardiac outcomes.

• The pathophysiology of this disease includes activation of the renin–angiotensin–aldosterone system.

• Optimal medical therapy includes an angiotensin blocker and statin, if tolerated by the patient.

• Appropriate diagnostic testing should be performed before endovascular intervention.

• For unselected patients, revascularization is not warranted.