Stenting for Renal-Artery Stenosis

Szender, J. Brian; Cannioto, Rikki A.; Gulati, Nicolas R.; Schmitt, Kristina; Friel, Grace; Minlikeeva, Albina N.; Platek, A.; Gower, Emily; Nagy, Ryan; Khachatryan, Edgar; Mayor, Paul; Kasza, Karin A.; Lele, Shashikant; Odunsi, Kunle; Moysich, Kirsten B.

doi:10.1056/nejmc1402687

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…Therefore, MD could be a marker of risk and not a risk factor per se. Post-hoc analyses could be performed to confirm the results of the present report in subjects with severe RAS (RAS ≥70%) and to look at the effect of MD-guided treatment of RAS (either medical treatment or revascularization) instead of the classical percentage of stenosis [20]. Moreover, the relationship between nontraditional cardiovascular risk factors, reduced arterial diameter, and poor outcome remains to be clarified.…”

Section: Discussionmentioning

confidence: 90%

Non-Hemodynamically Significant Renal Artery Stenosis Predicts Cardiovascular Events in Persons with Ischemic Heart Disease

et al. 2014

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Background/Aims: Recently, we reported that small renal arteries, defined by a low reference diameter (RD) or minimal luminal diameter (MD), are independently associated with a low GFR, resistant hypertension, and onset of contrast-induced nephropathy and suggested a post-hoc analysis of CORAL trial based on RD categories. Here we hypothesized that RD and MD are markers of nontraditional cardiovascular risk factors and tested whether low RD and MD could impact the prognosis of patients with ischemic heart disease. Methods: Prospective cohort study. We used proportional hazards models to analyze the first onset of cardiovascular events in relation with RD, MD, or percentage of renal artery stenosis (RAS) in those with low-to-moderate RAS (10-70%) (n = 181). Results: During the median follow-up of 4.5 (range, 0.1-5) years, 27.8% participants (n = 623; mean age, 64 years; 29% women) experienced a cardiovascular event (35.4% in those with RAS 10-70%). The presence of low-to-moderate RAS was associated with cardiovascular events. In these subjects, those with low MD were associated with a higher risk of cardiovascular events (MD >4.2 mm, HR: 1; MD 3.2-4.2 mm, HR: 1.66, 95% CI: 0.74-3.72, p = 0.22; MD <3.2 mm, HR: 3.72, 95% CI: 1.65-8.40, p = 0.002). When MD was added to a standard risk-factor model, risk prediction improvement was by 4.1%. Results were qualitatively similar if MD was replaced by RD or percentage of stenosis, but with smaller improvement of risk prediction and model fit. Conclusions: In patients with ischemic heart disease and low-to-moderate RAS, MD is a significant predictor of cardiovascular events, improves risk prediction, and may represent a valuable biomarker of cardiovascular disease risk. i 2014 S. Karger AG, Basel

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Section: Discussionmentioning

confidence: 90%

Non-Hemodynamically Significant Renal Artery Stenosis Predicts Cardiovascular Events in Persons with Ischemic Heart Disease

et al. 2014

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“…197,198 In the CORAL study, translesional renal artery pressure gradients were obtained, but are not yet published. 199 The ongoing controversy about the utility of renal revascularization is portrayed in many publications of pooled data, meta-analyses, and long-term follow-up data. In the absence of more convincing evidence of benefit (Figure 6), 200 it may be wise not to stent as a primary therapeutic option in patients with atherosclerotic renal artery stenosis unless hemodynamic relevance can be demonstrated or rapid deterioration in kidney function or worsening BP is evident.…”

Section: Renal Artery Stenting (Revascularization)mentioning

confidence: 99%

New Approaches in the Treatment of Hypertension

Oparil

Schmieder

2015

Circulation Research

237

137

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Hypertension is the most common modifiable risk factor for cardiovascular disease and death, and lowering blood pressure with antihypertensive drugs reduces target organ damage and prevents cardiovascular disease outcomes. Despite a plethora of available treatment options, a substantial portion of the hypertensive population has uncontrolled blood pressure. The unmet need of controlling blood pressure in this population may be addressed, in part, by developing new drugs and devices/procedures to treat hypertension and its comorbidities. In this Compendium Review, we discuss new drugs and interventional treatments that are undergoing preclinical or clinical testing for hypertension treatment. New drug classes, eg, inhibitors of vasopeptidases, aldosterone synthase and soluble epoxide hydrolase, agonists of natriuretic peptide A and vasoactive intestinal peptide receptor 2, and a novel mineralocorticoid receptor antagonist are in phase II/III of development, while inhibitors of aminopeptidase A, dopamine β-hydroxylase, and the intestinal Na + /H + exchanger 3, agonists of components of the angiotensin-converting enzyme 2/angiotensin(1–7)/Mas receptor axis and vaccines directed toward angiotensin II and its type 1 receptor are in phase I or preclinical development. The two main interventional approaches, transcatheter renal denervation and baroreflex activation therapy, are used in clinical practice for severe treatment resistant hypertension in some countries. Renal denervation is also being evaluated for treatment of various comorbidities, eg, chronic heart failure, cardiac arrhythmias and chronic renal failure. Novel interventional approaches in early development include carotid body ablation and arteriovenous fistula placement. Importantly, none of these novel drug or device treatments has been shown to prevent cardiovascular disease outcomes or death in hypertensive patients.

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