Atherosclerotic renal artery stenosis: PTRA or PTRAS does not improve outcomes compared with medical therapy


The aim of a study was to compare the efficacy of revascularization versus medical therapy in patients with atherosclerotic renal artery stenosis ( ARAS ).

Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and is associated with several complications, such as renal failure, coronary artery disease, cardiac destabilization, and stroke.
Medical therapy is the cornerstone for management of atherosclerotic renal artery stenosis; however, numerous trials have compared medical therapy with revascularization in the form of percutaneous renal artery angioplasty ( PTRA ) or percutaneous renal artery angioplasty with stent placement ( PTRAS ).

A literature search was done to identify clinical trials where medical therapy was compared with revascularization ( PTRA or PTRAS ).
Researchers performed a meta-analysis using a random effects model. The heterogeneity was assessed using I2 values.
The initial database search identified 540 studies and 7 randomized controlled trials, and 2,139 patients were included in the final analysis.

Angioplasty with or without stenting was not superior to medical therapy with respect to any outcome.

The incidence of nonfatal myocardial infarction was 6.74% in both the stenting and medical therapy group ( odds ratio, OR= 0.998, 95% confidence interval 0.698 to 1.427, p = 0.992 ), and incidence of renal events in stenting population was found to be 19.58% versus 20.53% in medical therapy ( OR= 0.945, 95% confidence interval 0.755 to 1.182, p = 0.620 ).

In conclusion, PTRA or PTRAS does not improve outcomes compared with medical therapy in patients with atherosclerotic renal artery stenosis.
Future studies should investigate to identify patient subgroups that may benefit from such an intervention.

Riaz IB et al, Am J Cardiol 2014;114:1116-1123



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