Timing and selection for renal revascularization in an era of negative trials: what to do?

Progress in Cardiovascular Diseases
Stephen C TextorJames F Glockner

Abstract

Management of atherosclerotic renal artery stenosis has become more complex with advances in both medical therapy and endovascular procedures. Results from recent trials fail to demonstrate major benefits of endovascular stenting in addition to optimal medical therapy. The general applicability of these results to many patients is limited by short-term follow-up and selection biases in recruitment. Many patients at highest risk were excluded from these studies and some were included with trivial lesions. Identification of patients with hemodynamically significant lesions remains a challenge and has led to more stringent criteria for Doppler ultrasound, measurement of translesional gradients and quantitative angiography. Although many patients can now be managed with medical therapy, it should be recognized that long-term reduction in antihypertensive drug requirements and recovery of kidney function are limited to those undergoing renal revascularization. As with any major vascular lesion, follow-up for disease stability and/or progression is essential. The ambiguity of present trial data may lead some to overlook selected subgroups that would benefit from restoring renal blood supply through revascularization. Further studies ...Continue Reading

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Citations

Aug 13, 2011·Current Hypertension Reports·Monika L GloviczkiStephen C Textor
Jul 13, 2012·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Niina KoivuviitaKaj Metsärinne
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Feb 4, 2014·Seminars in Nuclear Medicine·Alain Prigent, Philippe Chaumet-Riffaud
Nov 16, 2012·Kidney International·Stephen C TextorGustavo S Oderich
Jun 7, 2011·La Presse médicale·Thierry KrummelThierry Hannedouche
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Apr 12, 2014·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Sandra M S HerrmannStephen C Textor
Sep 25, 2010·American Journal of Hypertension·Stephen C Textor, Lilach Lerman
Jan 11, 2014·Clinical Journal of the American Society of Nephrology : CJASN·Stephen C Textor
Aug 4, 2019·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Satoshi UmemuraNobuhito Hirawa

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