Stenting versus medical therapy for atherosclerotic renal artery stenosis
Parsons, J, Ellery, B
Record ID 32018000687
Authors' results and conclusions: Early observational studies on stenting for renal artery stenosis showed promising results in terms of hypertension control and renal function, however the results have not been replicated in clinical trials. Recent meta-analyses including around 1,000 patients in each arm showed no benefit of angioplasty with stenting over medical therapy alone. These trials have been criticised for including patients with only mild and moderate disease; subgroup analyses on the groups with more severe disease has not been available to date. Despite a lack of trial evidence, there is still considerable support for the use of renal artery stenting in selected patient groups; namely those with flash pulmonary oedema, severe refractory hypertension or progressive decline in renal function.
Authors' recomendations: Despite a lack of robust clinical evidence to support its use, stenting for renal artery stenosis was introduced into routine clinical practice to prevent the progression of chronic kidney disease. It was thought that stenting would lower blood pressure, and as a consequence prevent the development of adverse cardiovascular and renal events. The pivotal CORAL study demonstrated that renal artery stenting proffers no clinical benefit for patients with severe stenosis and that comprehensive, multifactorial medical therapy is the preferred treatment option in these patients. It should be noted, however, that renal artery stenting may be appropriate for use in patients with acute pulmonary oedema, severe refractory hypertension or progressive decline in renal function. The number of renal stenting procedures performed in Australia and New Zealand has markedly reduced in recent years, however clinical practice guidelines still support its use. HealthPACT does not support the use of renal artery stenosis for patients with severe stenosis in clinical practice and recommends these patients are treated with multifactorial medical therapy. However, renal artery stenting should remain a treatment option for patients with acute pulmonary oedema, severe refractory hypertension or progressive decline in renal function. HealthPACT recommends the relevant Australian and New Zealand clinical practice guidelines be amended to reflect this change in clinical practice.
Project Status: Completed
Year Published: 2016
URL for published report: Not Available
English language abstract: An English language summary is available
Publication Type: Not Assigned
- Renal Artery Obstruction
- Retinal Artery Occlusion
Organisation Name: Adelaide Health Technology Assessment
Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617
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