Renal Artery Stenosis in 2011

In this issue of Vascular Disease Management we have a unique opportunity to obtain a global perspective on the management of renal artery stenosis. Certainly in the United States and Europe, management of atherosclerotic renal artery stenosis is an important issue for our aging populations and overburdened healthcare systems. Admittedly, much of what we read and hear about atherosclerotic renal artery stenosis refers to the recently published randomized trials including ASTRAL and STAR. The issues with these studies are well reviewed in two articles, one by Ritchie and Kalra and the other by Prasad and White. These articles carry the discussion beyond the current debate and provide somewhat contrasting views for the role of revascularization in patients with atherosclerotic renal stenosis. In addition Drs. Textor and Edwards lend their seasoned perspectives on the ongoing debate regarding reimbursement for renal artery revascularization. As participants in the 2007 MEDCAC advisory panel, their opinions are well thought out. We also have a contribution from Drs. Nel and Rayner in South Africa who present a case of renal artery stenosis with HIV as the etiology. As such, it is important to remember that not all stenoses of renal arteries are attributable to atherosclerosis. Several of the papers in the current issue refer to the management of fibromuscular dysplasia, another relatively common cause that appears to have favorable outcomes with angioplasty. An important issue that has received less attention is the evaluation of diagnostic modalities used to establish a diagnosis of renal artery stenosis. Zhang and Prince further our understanding of the tomographic imaging modalities of CTA and MRA. While most clinicians are able to appreciate “percent stenosis,” these authors highlight additional features of imaging that may relate to functional significance of the stenosis. Zeller and colleagues represent a group with exceptional experience in the management of renal artery stenosis and provide helpful guidance on interventional-endovascular techniques. In the next few years we can expect that new data will have an impact on the management strategy in these patients. Several cardiac-specific substudies are expected from the ASTRAL group in 2011. In addition, the CORAL trial is expected to complete follow-up sometime in the next several years. In the interim, when faced with patients presenting with known or suspected renal artery stenosis, consider the carpenter’s rule “measure twice, cut once.”

VASCULAR DISEASE MANAGEMENT 2011;8(2):E11

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From the Cardiovascular Division, University of Toledo, Toledo, Ohio. The authors report no conflicts of interest regarding the content herein. Address for correspondence: William R. Colyer, Jr., MD, Cardiovascular Division, University of Toledo, 3000 Arlington Avenue, Toledo, OH 43614. E-mail: william.colyer@utoledo.edu