What are ACC/AHA guidelines for percutaneous revascularization in renal artery stenosis (RAS)?

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

The ACC/AHA guidelines recommend percutaneous revascularization in patients with hemodynamically significant RAS and any of the following [56] :

  • Recurrent congestive heart failure or sudden unexplained pulmonary edema (class I)
  • Unstable angina (class IIa)
  • Accelerated, resistant, or malignant hypertension or hypertension with unexplained unilateral small kidney and intolerance to medication (class IIa)
  • Asymptomatic bilateral or single functioning kidney; however, this treatment is clinically unproven in asymptomatic unilateral hemodynamically significant RAS in a viable kidney (class IIb)

In addition, percutaneous revascularization is reasonable for patients with progressive chronic kidney disease (CKD) and bilateral RAS or a RAS to a single functioning kidney and can be considered for unilateral RAS with chronic renal insufficiency. [56] The ESC also recommends revascularization in patients with symptomatic fibromuscular dysplasia who have signs of organ ischemia. [57]


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