To stent or medicate?

This study compared the outcomes of two approaches for the treatment of atherosclerotic renal artery stenosis.

Atherosclerosis refers to the progressive hardening and narrowing of the arteries, and is the major cause of hypertension (high blood pressure) among adults. Sever atherosclerosis may cause significant narrowing of the artery to the kidney, referred to as renal artery stenosis. Since the kidneys depend on a constant supply of blood, renal artery stenosis is a serious condition that may result in severe hypertension, kidney damage and eventually heart failure.

The two main approaches for the treatment of renal artery stenosis include intensive medication with a variety of anti-hypertensive drugs, and renal artery stenting. Renal artery stenting is a minimally invasive surgical procedure in which a wire mesh, called a stent, is placed within the narrowed artery to restore normal blood flow. However, whether or not renal artery stenting provides any further benefit to patients, beyond that provided by medications, is currently under debate.

947 patients with atherosclerotic renal artery stenosis were included in this trial. Patients were randomly assigned into one of two groups. 480 patients received standard medical therapy (including anti-hypertensive medications) alone, while 467 patients received standard medical therapy and underwent a renal artery stenting procedure. Patients were followed for an average of 43 months.

Among patients receiving renal artery stenting, slightly lower blood pressure values were noted compared to patients receiving standard medical therapy alone. However, no significant differences were noted regarding overall survival between the two treatment groups. In addition, no differences were noted regarding the amount of specific complications reported. For example, 5.9% of patients receiving renal artery stenting eventually developed heart failure, compared to 5.5% of patients receiving standard medical therapy alone.

This trial concluded that renal artery stenting does not provide any additional benefit over standard medical treatment in the management of atherosclerotic renal artery stenosis.