Renal Artery Stenting – Developments in Practice

Abstract

Significant renal artery stenosis (RAS) is a well-accepted cause of arterial hypertension and renal insufficiency. Technical improvements of diagnostic and interventional endovascular tools have led to more widespread use of endoluminal renal artery revascularisation and the extension of the indications for this type of therapy during the past two decades. Since the first renal artery angioplasties were performed by Felix Mahler and Andreas Grüntzig, numerous single-centre studies have reported the beneficial effect of percutaneous transluminal renal angioplasty, and since the early 1990s stenting of RAS caused by either atherosclerosis or fibromuscular dysplasia. However, none of the published or presented randomised controlled trials (RCTs) prove a beneficial outcome of RAS revascularisation compared with medical management. As a result of these negative trials, including the recently published or presented STAR and ASTRAL trials, referrals to endovascular renal artery revascularisation have decreased and, moreover, reimbursement of these procedures has become a matter of debate. This article provides an overview of the state-of-the-art endovascular technique of renal artery stenting and discusses the limitations of the published trials, highlighting the crucial aspect of proper patient selection.