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Research Review - Final – Oct. 24, 2006
Comparative Effectiveness of Management Strategies for Renal Artery Stenosis
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This report summarizes the evidence evaluating the effect and safety of angioplasty with stent placements and medical therapies in the treatment of atherosclerotic renal artery stenosis (ARAS), particularly after long-term followup. The key questions and principal definition of terms were determined with the assistance of a technical expert panel.
Key questions addressed in this report are: 1. For patients with atherosclerotic renal artery stenosis in the modern management era (i.e., since JNC-5 in 1993a), what is the evidence on the effects of aggressive medical therapy (i.e., antihypertensive, antiplatelet, and antilipid treatment) compared to renal artery angioplasty with stent placement on long-term clinical outcomes (at least 6 months), including blood pressure control, preservation of kidney function, flash pulmonary edema, other cardiovascular events, and survival? 1a. What are the patient characteristics, including etiology, predominant clinical presentation, and severity of stenosis, in the studies? 1b. What adverse events and complications have been associated with aggressive medical therapy or renal artery angioplasty with stent placement? 2. What clinical, imaging, laboratory, and anatomic characteristics are associated with improved or worse outcomes when treating with either aggressive medical therapy alone or renal artery angioplasty with stent placement? 3. What treatment variables are associated with improved or worse outcomes of renal artery angioplasty with stent placement, including periprocedural medications, type of stent, use of distal protection devices, or other adjunct techniques?