Keywords:
Hypertension, Arteriosclerosis, Stents, Angioplasty, Fluoroscopy, Catheter arteriography, Kidney, Interventional vascular, Arteries / Aorta
Authors:
C. Cecchelli, D. Attinà, M. Di Carlo, A. Casadei, M. Zompatori; Bologna/IT
DOI:
10.1594/ecr2013/C-2187
Purpose
Aterosclerotic stenosis of renal artery (ASRA) represents a common condition related to hypertension,
progressive renal failure and cardiovascular morbidity [1,2].
The clinical efficacy of endovascular therapy of renal artery stenosis is still controversial [3].
According to the results of two important randomized and controlled trials (ASTRAL and STAR) there were not a significant advantage of endovascular procedures compared to medical therapy alone,
in improving renal function and blood pressure values [4,5,6].
These two studies should be anyway considered not conclusive,
because of their intrinsic bias.
First of all patients without hemodynamic significative stenosis and patients with uncertain indications for renal artery stent placement (RASP) were included in these trials.
Several studies confronting RASP to medical therapy alone are still in course.
In detail one of these,
the CORAL trial (Cardiovascular outcomes in renal atherosclerotic lesions),
should be mentioned.
Primary endpoint of CORAL study is to evaluate if a significative difference in terms of renal function improvement and cardiovascular morbidity/mortality incidence between two groups of patients (treated with RASP and medical therapy vs medical therapy alone) is present [7].
Waiting for the results of CORAL and other trials,
we retrospectively assessed our five year experience of RASP in patients affected by ASRA.
Immediate technical success and long term impact on renal function and blood pressure values (up to two years) were evaluated.
Only patients with defined indications for the endovascular treatment were included in our study.