This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Google Scholar Articles by Dubel, G. J Articles by Murphy, T. P PubMed PubMed Citation Articles by Dubel, G. J Articles by Murphy, T. P Social Bookmarking                   What's this?

The role of percutaneous revascularization for renal artery stenosis

Department of Diagnostic Imaging, Brown University Medical School, Division of Interventional Radiology, Providence, Rhode Island, USA

Timothy P Murphy

Department of Diagnostic Imaging, Brown University Medical School, Division of Interventional Radiology, Providence, Rhode Island, USA

Abstract

Renal artery stenosis (RAS) is usually caused by atherosclerosis or fibromuscular dysplasia. RAS leads to activation of the renin-angiotensin-aldosterone system and may result in hypertension, ischemic nephropathy, left ventricular hypertrophy and congestive heart failure. Management options include medical therapy and revascularization procedures. Recent studies have shown angiotensin receptor blockers (ARB) and angiotensin converting enzyme inhibitors (ACE-I) to be highly effective in treating the hypertension associated with RAS and in reducing cardiovascular events; however, they do not correct the underlying RAS and loss of renal mass may continue. Renal artery angioplasty was first performed by Gruntzig in 1978. The routine use of stents has increased technical success rates compared with angioplasty, and surgery is now only rarely performed. Although numerous case series claimed benefit in terms of blood pressure control, no adequately powered randomized, controlled, prospective study of renal artery interventions has reported their effect on cardiovascular morbidity or mortality. The CORAL trial, an ongoing study of renal artery stent placement and optimal medical therapy (OMT) funded by the National Institutes of Health, is the first study to attempt to do so. Until the CORAL trial results are in, physicians will continue to be faced with difficult choices when determining the optimal management for RAS patients and deciding which, if any, patients should be offered revascularization.

Key Words: hypertension • renal angioplasty • renal artery stenosis • renal artery stent • renal revascularization

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?