Renal artery stenting in the correct patients with atherosclerotic renovascular disease: time for a proper renal and cardiovascular outcome study?
Marieta P TheodorakopoulouArtemios G KaragiannidisCharles Joseph FerroAlberto Ortiz ArduanPantelis A SarafidisPublished in: Clinical kidney journal (2022)
Atherosclerotic renovascular disease (ARVD) represents the most common type of renal artery stenosis. In the last decade, a few large trials failed to demonstrate the superiority of standard medical therapy plus percutaneous transluminal renal angioplasty (PTRA) compared with medical therapy alone in lowering blood pressure levels or preventing adverse renal and cardiovascular outcomes in patients with ARVD. However, this issue remains controversial and an ongoing debate focusses on the benefits that selected patients could experience from renal revascularization procedures. In this regard, several pieces of observational data show that PTRA is associated with future cardiorenal benefits in patients presenting with high-risk ARVD phenotypes. Such evidence resulted in a progressive shift in relevant recommendations, with most recent not-graded suggestions supporting that revascularization should be offered in these high-risk subjects. Existing evidence clearly calls for a properly designed randomized controlled trial with selected patients presenting high-risk ARVD phenotypes, in order to confirm the superiority of PTRA versus non-invasive management in this patient group and objectively guide everyday clinical practice.
Keyphrases
- end stage renal disease
- randomized controlled trial
- blood pressure
- clinical practice
- ejection fraction
- newly diagnosed
- healthcare
- chronic kidney disease
- emergency department
- peritoneal dialysis
- multiple sclerosis
- physical activity
- coronary artery disease
- type diabetes
- systematic review
- patient reported outcomes
- minimally invasive
- adipose tissue
- coronary artery bypass grafting
- metabolic syndrome
- bone marrow
- ultrasound guided
- insulin resistance
- big data
- cross sectional
- machine learning
- antiplatelet therapy
- acute coronary syndrome