What are the benefits of the addition of stenting to medical therapy for renal artery stenosis?

Updated: Nov 02, 2020
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

The Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study demonstrated no added benefit from the addition of stenting to medical therapy for renal artery stenosis. In CORAL, 947 participants with atherosclerotic renal-artery stenosis and either systolic hypertension or chronic kidney disease were randomized to medical therapy plus renal artery stenting or medical therapy alone. The resulting rate of adverse cardiovascular and renal events (ie, death, myocardial infarction, stroke, hospitalization for heart failure, progressive kidney insufficiency, or the need for renal replacement therapy) showed no significant differences (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% CI, 0.76 to 1.17; P = 0.58). [47]

However, a post hoc analysis of CORAL by Murphy et al found that in patients whose baseline urine albumin/creatinine ratio was at or below the median (22.5 mg/g), renal artery stenting was associated with significantly better outcome, including event-free survival, cardiovascular disease–related death, progressive kidney insufficiency, and overall survival. The authors suggest that low albuminuria may identify a potentially large subgroup of renal artery stenosis patients who would benefit from stent placement plus medical therapy. [48]


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