Renal artery stenosis: a review of therapeutic options.

Renal artery stenosis (RAS) has traditionally been under recognized in clinical medicine as a cause of secondary hypertension and as a culprit for progressive ischemic nephropathy. While it is well recognized that atherosclerotic RAS is a progressive disease, and that surgical revascularization may result in lowering of blood pressure and prevention of progression of nephropathy, the high morbidity and mortality associated with surgical revascularization has kept the enthusiasm for revascularization low. With the recent advances in renal artery stent revascularization, a procedure that can be accomplished with <1% major complication rate, 90-95% success rate and 10-15% restenosis rate, multiple studies have reported the salutary hemodynamic benefits and increased awareness of prevalence of RAS in patients with vascular disease. Multiple studies have reported sustained blood pressure control in 70-80% of patients, stabilization of renal function in a similar percentage of patients and beneficial effect of renal artery stenting in patients with angina or heart failure. Further advances in therapy consisting of distal protection to diminish procedural atheroembolism and aggressive adjunctive medical therapy may allow clearly demonstrable benefits of renal artery stenting in prevention of ischemic nephropathy and reduction of cardiovascular events.