Diagnosis and management of atherosclerotic renal artery stenosis: Improving patient selection and outcomes

White, Christopher J. and Olin, Jeffrey W. (2009) Diagnosis and management of atherosclerotic renal artery stenosis: Improving patient selection and outcomes. Nature Clinical Practice Cardiovascular Medicine, 6 3: 176-190. doi:10.1038/ncpcardio1448


Author White, Christopher J.
Olin, Jeffrey W.
Title Diagnosis and management of atherosclerotic renal artery stenosis: Improving patient selection and outcomes
Journal name Nature Clinical Practice Cardiovascular Medicine   Check publisher's open access policy
ISSN 1743-4297
1743-4300
Publication date 2009-03
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1038/ncpcardio1448
Volume 6
Issue 3
Start page 176
End page 190
Total pages 15
Place of publication London, United Kingdom
Publisher Nature Publishing Group
Language eng
Abstract Renal artery stenosis (RAS) is common among patients with atherosclerosis, and is found in 20–30% of individuals who undergo diagnostic cardiac catheterization. Renal artery duplex ultrasonography is the diagnostic procedure of choice for screening outpatients for RAS. Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS, and is favored over balloon angioplasty alone. Stent placement carries a class I recommendation for atherosclerotic RAS according to ACC and AHA guidelines. Discordance exists between the very high (>95%) procedural success rate and the moderate (60–70%) clinical response rate after renal stent placement, which is likely to be a result of poor selection of patients, inadequate angiographic assessment of lesion severity, and the presence of renal parencyhmal disease. Physiologic lesion assessment using translesional pressure gradients, and measurements of biomarkers (e.g. brain natriuretic peptide), or both, could enhance the selection of patients and improve clinical response rates. Long-term patency rates for renal stenting are excellent, with 5-year secondary patency rates greater than 90%. This Review will outline the clinical problem of atherosclerotic RAS and its diagnosis, and will critically assess treatment options and strategies to improve patients' outcomes.
Keyword Ischemic nephropathy
Renal artery atherosclerosis
Renal artery stent
Renovascular hypertension
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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Created: Mon, 14 Mar 2011, 10:31:52 EST