Percutaneous revascularization of the kidney: conventional angioplasty versus renal artery stenting

Renal artery stenosis (RAS) is the most common cause of secondary hypertens ion, with a prevalence of about 1% in the general population of people with hypertension. Severe arterial stenosis may also lead to impairment of excr etory renal function. In experienced hands renal artery revascularization with or without stent i mplantation may be a safe and effective treatment in patients with sustaine d hypertension resistant to intensive antihypertensive treatment. Conventio nal balloon angioplasty of nonostial RAS caused by fibromuscular dysplasia with a high technical and functional success rate may be the treatment of c hoice. However, there is continous discussion concerning the utility of bal lon angioplasty and renal stenting, respectively in patients with atheroscl erotic disease. At the time being, there are 3 randomized European trials o ngoing to analyze the benefit of medical treatment Versus percutaneous inte rvention. Several prospective studies dealing with renal artery stenting in ostial RAS found that the implantation of endoprostheses leads to much bet ter morphologic longterm results as compared to those of balloon angioplast y alone and may be a safe and effective alternative to surgery. In addition , the functional results suggest that stent implantation in patients with m ild or severe renal dysfunction may slow progression of renal failure and, thus delay the need for renal replacement therapy. It is to note that renal artery stenting does not impede any further surgical intervention. However, prior to any interventional treatment the indication of an eventua l catheter procedure in patients with RAS should be discussed between exper ienced nephrologists and interventionalists based on clinical, functional a nd duplexsonographic data.