Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis

Abstract

New search has been performed Secondary references added to included studies. NITER and CORAL trials added to ongoing studies.

Efficacy of Antihypertensive Therapy in a Child with Unilateral Focal Fibromuscular Dysplasia of the Renal Artery: A Case Study and Review of Literature

“…Therapeutic decision in RAS, including renal artery FMD, depends on the nature and location of vascular lesion (stenosis versus dissection versus aneurysm), the severity of hypertension and efficacy of the anti-hypertensive therapy, the size of the patient, and comorbid conditions. Meta-analyses of randomized trials and Cochrane reviews have shown that there is not an enough evidence to support the routine use of revascularization procedures (ballooning and/or stenting) in the treatment of symptomatic patients with RAS [20][21][22]. A 2003 Cochrane systematic review of three randomized controlled trials involving 210 patients with RAS was unable to conclude that balloon angioplasty is superior to medical therapy in lowering BP in those in whom BP can be controlled with medical therapy [20].…”

“…However, the study did find that in patients with refractory hypertension, balloon angioplasty more effectively lowered BP than medical therapy alone. Similarly, a subsequent Cochrane review published in 2014 showed insufficient evidence that revascularization with or without stenting is superior to medical therapy in hypertensive patients with RAS [21]. It is important to mention that both of these reviews looked at adult patients with RAS secondary to atherosclerosis.…”

Renal angioplasty does not improve clinical outcomes compared to standard medical therapy in patients with atherosclerotic renal artery stenosis

“…16 A Cochrane review of eight randomized controlled trials also supported the conclusions drawn from the CORAL trial, which will be critically appraised below. 17…”

Long-term outcomes and determinants of stenosis recurrence after renal artery angioplasty in hypertensive patients with renovascular disease

“…The immediate result of PTA is characterised by a high success rate and fairly low periprocedural complication rate [5][6][7]. However, the clinical improvement following PTA of RAS is uncertain [5][6][7][8].…”

“…The immediate result of PTA is characterised by a high success rate and fairly low periprocedural complication rate [5][6][7]. However, the clinical improvement following PTA of RAS is uncertain [5][6][7][8]. The effect of PTA is probably a complex issue, as both the effect of PTA on renal function and systolic/diastolic blood pressure (SBP/ DBP), as well as cardiovascular adverse events is at least controversial [6,9,10].…”