Abstract

PEDRO, Luís Mendes  and  FERNANDES E FERNANDES, José. ASTRAL and CORAL studies: The end of renal endoluminal revascularization in atherosclerosis or a new begining?. Angiol Cir Vasc [online]. 2014, vol.10, n.1, pp.03-07. ISSN 1646-706X.

Renal artery stenosis is a cause of arterial hypertension in around 1-4% of all hypertensive population but some selected groups seem to have higher prevalence and, as in other arterial territories, stenosis frequently progress to complete occlusion and loss of renal function. Contemporary treatment is based on three options: isolated medical treatment, conventional surgery and endovascular stenting. Conventional surgery continues to have a de?nite role in selected patients. Modern endovascular intervention for atherosclerotic occlusive renal disease uses lower pro?le introducers, guiding-catheters and guidewires as well as the systematic stent deployment and is associated to high technical success and low risk; nevertheless, the rate of restenosis is 10-20% and a close monitorization in the follow-up is advised. These good results from personal or institutional series were not reproduced in larger prospective trials where higher risk patients and most clear indications may have been excluded. The authors discuss the limitations and pitfalls of the randomized trials and defend that renal artery stenting should be performed selectively in the classical clinical indications in patients with tight stenosis which hemodynamic impact should be assessed systematically. In asymtomatic patients and or with less stenotic lesions medical treatment is indicated and a careful assessment should be undertaken before any type of revascularization is considered.

Keywords : Renal artery stenosis; Stenting; Present indications.

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