Timing and Selection for Renal Revascularization in an Era of Negative Trials: What to Do?

摘要: Management of atherosclerotic renal artery stenosis has become more complex with advances in both medical therapy and endovascular procedures. Results from recent trials fail to demonstrate major benefits stenting addition optimal therapy. The general applicability these results many patients is limited by short-term follow-up selection biases recruitment. Many at highest risk were excluded studies some included trivial lesions. Identification hemodynamically significant lesions remains a challenge led stringent criteria for Doppler ultrasound, measurement translesional gradients quantitative angiography. Although can now be managed therapy, it should recognized that long-term reduction antihypertensive drug requirements recovery kidney function are those undergoing revascularization. As any vascular lesion, disease stability and/or progression essential. ambiguity present trial data may lead overlook selected subgroups would benefit restoring blood supply through Further precisely identify kidneys recover beyond meaningful Considering the comorbid risks population, will remain imperative clinicians consider hazards, costs carefully each patient determine role timing