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Angioplasty for atheromatous renal artery stenosis: current knowledge and trial results awaited

Journal of Human Hypertension volume 21, pages 507–508 (2007)Cite this article

There is always great excitement in the blood pressure clinic when we encounter a patient with renal artery stenosis. In the majority this is due to atheromatous renal artery stenosis (ARAS). Some of these patients are referred for revascularisation, nowadays largely by angioplasty and stenting. The excitement wanes however when the results of this treatment, in terms of the reduction of blood pressure at least, are disappointing. Prior to the advent of renal angioplasty, these patients were subjected to surgical reconstruction of their renal arteries. In the MRC Blood Pressure Unit in Glasgow, they used somewhat cynically to refer to this procedure as ‘a two-stage nephrectomy’. An enthusiastic vascular surgeon would operate for several hours on a patient's kidney on Monday, which would ultimately prove unsuccessful, and on the following Friday the surgeon would remove the kidney. Percutaneous transluminal angioplasty (PCTA) has at least improved things in terms of immediate morbidity, and possibly mortality, but the questions remain. What is the value of renal revascularisation in patients with ARAS (Table 1)?

Table 1
Full size table

There have been numerous case series published of renal angioplasty with or without stenting and the results in general are not very encouraging.1 In terms of hypertension, about 50 per cent obtain some benefit with improved blood pressure control, in between 25 and 30% the hypertension is unchanged and in only around 10% is it ‘cured’. One of the reasons for this is patients with ARAS tend to have generalised atheromatous disease throughout their coronary and cerebral circulation as well as their peripheral vessels.2 In a sense the atheroma in ARAS is not so much the cause of the high blood pressure but rather the consequence of the atheromatous process for which hypertension is a major contributor. It would therefore be surprising if the high blood pressure were to be ‘cured’ by a revascularisation procedure so late on in the pathological process of hypertension with its associated atheromatous deposition.

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  1. Department of Medicine, City Hospital, Birmingham, UK

    S Srivastava & D G Beevers

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Correspondence to D G Beevers.

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Srivastava, S., Beevers, D. Angioplasty for atheromatous renal artery stenosis: current knowledge and trial results awaited. J Hum Hypertens 21, 507–508 (2007). https://doi.org/10.1038/sj.jhh.1002186

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