Clinical outcomes after percutaneous revascularization versus medical management in patients with significant renal artery stenosis: A meta-analysis of randomized controlled trials

Meta-Analysis of Revascularization Versus Medical Therapy for Atherosclerotic Renal Artery Stenosis

“…We present an updated analysis of all clinically relevant outcomes (nonfatal MI, renal events, changes in systolic blood pressure from baseline, CHF, stroke, and death) presented in clinical trials and older metaanalyses. 22,23 Our results confirm those of Kumbhani et al 22 and Pierdomenico et al 23 who suggested that PTRA and PTRAS are not superior to medical therapy alone with respect to all-cause mortality, nonfatal MI, and stroke. Our results contrast those of a recent individual patient meta-analysis, which showed that systolic blood pressure and diastolic blood pressure were significantly lower at 9 months after renal artery stent revascularization.…”

The utility of renal venous renin studies in selection of patients with renal artery stenosis for angioplasty

“…Recent randomized controlled trials have attempted to evaluate whether angioplasty in patients with significant RAS but without compelling indications would result in decreased progression of renal impairment and/or occurrence of cardiovascular adverse events [4][5][6]. In these studies, revascularization did not yield further benefits beyond medical treatment alone, possibly because of failure of the procedures to provide additional BP reduction compared with the control intervention.…”

Does Renal Artery Stenting Prevent Clinical Events?

“…Remarkably, nearly all of these trials have failed to identify much added clinical benefit from renal revascularization, which we and others have reviewed (9,10). Recruitment of patients with clinically significant ARVD to participate in randomized trials has been difficult, however, partly because of the established success of revascularization in patients with extreme cases.…”