TY - JOUR
T1 - Renal artery stenosis-when to screen, what to stent?
AU - Jennings, Claudine G.
AU - Houston, John G.
AU - Severn, Alison
AU - Bell, Samira
AU - Mackenzie, Isla S.
AU - MacDonald, Thomas M.
PY - 2014/6
Y1 - 2014/6
N2 - Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed.
AB - Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed.
KW - Atherosclerosis
KW - Fibromuscular dysplasia
KW - Percutaneous transluminal renal artery angioplasty
KW - Renal artery stenosis
UR - http://www.scopus.com/inward/record.url?scp=84901197002&partnerID=8YFLogxK
U2 - 10.1007/s11883-014-0416-2
DO - 10.1007/s11883-014-0416-2
M3 - Article
C2 - 24743868
VL - 16
JO - Current Atherosclerosis Reports
JF - Current Atherosclerosis Reports
SN - 1523-3804
IS - 6
M1 - 416
ER -