Renal artery stenting for atherosclerotic renal artery stenosis: A review of contemporary data.

Renal artery stenting has been less frequently performed following the results of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions trial. In this trial, stenting demonstrated no benefit over medical therapy in a composite outcome including mortality as well as cardiovascular and renal events. However, these findings must be interpreted in the context of the study population, which included many patients less likely to benefit from intervention due to relatively mild renal artery stenosis, as well as less severe hypertension and renal dysfunction. More recent investigations have focused on identifying subgroups of patients who may benefit from revascularization. Identified subgroups include patients with high systolic blood pressure, diastolic hypertension, worsening kidney function, greater antihypertensive burden, flash pulmonary edema, and mild-range proteinuria. Many of these variables illustrate a clinical picture of a patient with severe ischemic kidney disease leading to problems with hypertension and volume regulation that has not yet irreparably damaged the renal parenchyma. Deciding which patients fit into this picture, and therefore should be stented, presents a challenge. This review synthesizes the current evidence surrounding these predictive variables and explores how they may be integrated into clinical decision-making.