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

Full Text via DOI: 10.1038/ncpcardio1448 PMID: 19234498 Web of Science: 000263570200011

Cited authors

  • White, Christopher J.; Olin, Jeffrey W.


  • 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. Longterm 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.

Publication date

  • 2009

International Standard Serial Number (ISSN)

  • 1743-4297

Start page

  • 176

End page

  • 190


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