Update on Interventions in Renal Artery Stenosis

Noninvasive techniques such as ultrasound and renal scanning have improved the frequency of detection of renal artery stenosis in patients with arterial hypertension, renal insufficiency, or multivascular disease. The results of conventional balloon angioplasty on nonostial renal artery stenoses caused by fibromuscular dysplasia or atherosclerosis showed a high recurrence rate and a moderate impact on the management of hypertension. In patients with ostial lesions, the results of angioplasty were disappointing with low initial success rates and a high rate of restenosis. Other limitations of balloon angioplasty include initial failure or suboptimal result, occluding dissection, and short- or mid-term restenosis. The immediate procedural results of renal artery stenting are excellent, with a low complication rate and satisfactory restenosis rate. Long-term effects on renal function and blood pressure seem to be good. Systematic stent placement is indicated for ostial stenosis. For nonostial lesions, the indication for stent placement may be reserved for residual stenosis or dissection. The indication for a stent would probably be more liberal in cases of bilateral lesions or lesions in a solitary kidney. Multicenter studies probably will be needed to assess the indications and benefits obtained in different clinical and anatomical situations.