Renal artery stenting in the correct patients with atherosclerotic renovascular disease: time for a proper renal and cardiovascular outcome study?

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.

Automated summary

Atherosclerotic renovascular disease is the most common type of renal artery stenosis. Several large trials have failed to demonstrate the superiority of percutaneous transluminal renal angioplasty (PTRA) in addition to medical therapy compared to medical therapy alone in patients with ARVD. However, observational data suggest that PTRA may have cardiorenal benefits in high-risk ARVD patients, warranting a properly designed randomized controlled trial to confirm its superiority.