What is the evidence for the use of revascularization in the treatment of 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

A metal-analysis of revascularization versus medical therapy for the treatment of renal artery stenosis found no clear benefit from percutaneous transluminal angioplasty with or without stenting over medical management. In the final analysis, which included 540 studies and seven randomized controlled trials and 2,139 patients, angioplasty with or without stenting was not superior to medical therapy with respect to any outcome. The incidence of nonfatal myocardial infarction was 6.74% in both the stenting and medical therapy group (odds ratio 0.998, 95% CI 0.698 to 1.427, P = 0.992), and the incidence of renal events with stenting population was 19.58% versus 20.53% with medical therapy (odds ratio 0.945, 95% CI 0.755 to 1.182, P = 0.620). [49]

Revascularization may not result in restoration of kidney function because of damage sustained during the period of reduced blood flow. [6] Hypoxia can result in functional loss of microcirculation (rarefaction) and recruitment of inflammatory cellular elements (as indicated by elevation of inflammatory biomarkers [50] ) that ultimately produce fibrosis. [40]

However, there is also evidence that percutaneous revascularization may benefit some patients in high-risk subgroups. In a retrospective analysis of a single-center prospective cohort study of 467 patients, Ritchie and colleagues reported that those individuals presenting with flash pulmonary edema, rapidly declining kidney function, or refractory hypertension who received revascularization had a significantly reduced risk for death and cardiovascular events compared to those who received medical management. [51]


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