CER Management Strategies for Renal Artery Stenosis: 2014 Update

Project Summary Title and Description

CER Management Strategies for Renal Artery Stenosis: 2014 Update
An update of the 2006 and 2007 CERs comparing medical treatment, angioplasty+-stenting, and open vascular procedures for atherosclerotic renal artery stenosis. The update reviews only angioplasty with stenting (not an update of angioplasty without stenting).
Authors of Report
Methodology description
See: https://effectivehealthcare.ahrq.gov/ehc/products/606/2037/renal-update-2015-150115.pdf
Report available at https://effectivehealthcare.ahrq.gov. Manuscript available at www.annals.org.
Funding Source

Key Questions

1. 1. For patients with atherosclerotic renal artery stenosis in the modern management era (i.e., since JNC-5 in 1993*), what is the evidence on the effects of aggressive medical therapy (i.e., antihypertensive, antiplatelet, and antilipid treatment) compared to renal artery angioplasty with stent placement on long-term clinical outcomes (at least 6 months) including blood pressure control, preservation of kidney function, flash pulmonary edema, other cardiovascular events, and survival? 1a. What are the patient characteristics, including etiology, predominant clinical presentation, and severity of stenosis, in the studies? 1b. What adverse events and complications have been associated with aggressive medical therapy or renal artery angioplasty with stent placement?
2. 2. What clinical, imaging, laboratory and anatomic characteristics are associated with improved or worse outcomes when treating with either aggressive medical therapy alone or renal artery angioplasty with stent placement?
3. 3. What treatment variables are associated with improved or worse outcomes of renal artery angioplasty with stent placement, including periprocedural medications, type of stent, use of distal protection devices, or other adjunct techniques?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

Renal artery stenting in patients with chronic ischemic heart disease.2010
Predicting blood pressure response after renal artery stenting.2010
Do patients undergoing renal revascularization outside of the ASTRAL trial show any benefit? Results of a single-centre observational study.2012
Renal artery stenting with noninvasive duplex ultrasound follow-up: 3-year results from the RENAISSANCE renal stent trial.2008
Embolic protection and platelet inhibition during renal artery stenting.2008
Renal artery revascularization in patients with atherosclerotic renal artery stenosis and impaired renal function: conservative management versus renal artery stenting.2010
Improved renal function and blood pressure control following renal artery angioplasty: the renal artery angioplasty in patients with renal insufficiency and hypertension using a dedicated renal stent device study (PRECISION).2008
Early duplex predicts restenosis after renal artery angioplasty and stenting.2012
Use of B-type natriuretic peptide to predict blood pressure improvement after percutaneous revascularisation for renal artery stenosis.
Nine-month results of the REFORM study: a prospective, single-arm, multicenter clinical study of the safety and effectiveness of the Formula™ balloon-expandable stent for treatment of renal artery stenosis.2013
Predictor factors for renal outcome in renal artery stenosis.2013
Long-term follow-up of renal artery stenting in an Australian population.2007
Enhanced flow velocity after stenting of renal arteries is associated with decreased renal function.2007
Diastolic function predicts survival after renal revascularization.2011
One year clinical outcomes of renal artery stenting: the results of ODORI Registry.2010
Clinical efficacy of percutaneous renal revascularization with stent placement in atherosclerotic renovascular disease.2007
Stenting and medical therapy for atherosclerotic renal-artery stenosis.2014
Revascularization versus medical therapy for renal artery stenosis: antihypertensive drugs and renal outcome.
Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.2009
Effect of renal artery stenting on left ventricular mass: a randomized clinical trial.2012
Predictive factors and therapeutic approach of renovascular disease: four years' follow-up.2008
Cardiac benefits of renal artery stenting.2010
Objective performance goals of safety and blood pressure efficacy for clinical trials of renal artery bare metal stents in hypertensive patients with atherosclerotic renal artery stenosis.2011
Screening, diagnosis, and treatment of renal artery stenosis by percutaneous transluminal renal angioplasty with stenting.2010
Clinical utility of the resistive index in atherosclerotic renovascular disease.2009
Durability of renal artery stents in patients with transrenal abdominal aortic endografts.2007
Sirolimus-eluting versus bare-metal low-profile stent for renal artery treatment (GREAT Trial): angiographic follow-up after 6 months and clinical outcome up to 2 years.2007
Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis.
High-risk clinical presentations in atherosclerotic renovascular disease: prognosis and response to renal artery revascularization.2014
Long-term safety and efficacy of renin-angiotensin blockade in atherosclerotic renal artery stenosis.2012
Comparison of early and long-term impact of percutaneous transluminal renal artery angioplasty alone or with brachytherapy on renal function in patients with reno-vascular hypertension.2008
Experience of stenting for atherosclerotic renal artery stenosis in a cardiac catheterization laboratory: technical considerations and complications.2009
Pleiotropic effects of statins may improve outcomes in atherosclerotic renovascular disease.2008
Significant reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: results from the HERCULES trial.2012
Long-term follow-up of patients with atherosclerotic renal artery disease.2013
Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome.2011
Renovascular hypertension. 8 years experience of a vascular surgery centre.2007
Revascularization versus medical therapy for renal-artery stenosis.2009
Renal artery stenting slows the rate of renal function decline.2007
Prediction of hypertension improvement after stenting of renal artery stenosis: comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography.2009
The benefit of renal artery stenting in patients with atheromatous renovascular disease and advanced chronic kidney disease.2010
Different outcomes of atherosclerotic renal artery stenosis managed with stenting: results from a cohort study.2012
Proper patient selection yields significant and sustained reduction in systolic blood pressure following renal artery stenting in patients with uncontrolled hypertension: long-term results from the HERCULES trial.2014
Statins and renovascular disease in the elderly: a population-based cohort study.2011
Intravascular ultrasound-guided renal artery stenting.2001
Prospective randomized trial of operative vs interventional treatment for renal artery ostial occlusive disease (RAOOD).2009
Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis.2010
Impact of carbon coating on the restenosis rate after stenting of atherosclerotic renal artery stenosis.2005
Atherosclerotic renal arterial stenosis: clinical outcomes of stent placement for hypertension and renal failure.2003
Dispelling the myth: the use of renin-angiotensin blockade in atheromatous renovascular disease.2012
Multicenter Palmaz stent renal artery stenosis revascularization registry report: four-year follow-up of 1,058 successful patients.2002
Renal insufficiency as a predictor of adverse events and mortality after renal artery stent placement.2003
Renal artery stent placement: utility in lesions difficult to treat with balloon angioplasty.1997
Treatment of ostial renal-artery stenoses with vascular endoprostheses after unsuccessful balloon angioplasty.1997
Renal artery stent revascularization with embolic protection in patients with ischemic nephropathy.2006
Effect of primary balloon expandable renal artery stents on long-term patency, renal function, and blood pressure in hypertensive and renal insufficient patients with renal artery stenosis.1996
Renal angioplasty and stenting under protection: the way for the future?2003
Low-profile stent system for treatment of atherosclerotic renal artery stenosis: the GREAT trial.2005
Arterial stenting and balloon angioplasty in ostial atherosclerotic renovascular disease: a randomised trial.1999
Effect of renal-artery stenting on progression of renovascular renal failure.1997
Long-term follow-up of atherosclerotic renovascular disease. Beneficial effect of ACE inhibition.2005
Predictors for clinical success at one year following renal artery stent placement.2002
Randomised comparison of percutaneous angioplasty vs continued medical therapy for hypertensive patients with atheromatous renal artery stenosis. Scottish and Newcastle Renal Artery Stenosis Collaborative Group.1998
Stenting of renal artery stenosis: is it beneficial in chronic renal failure?2005
Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure.2002
Ostial renal artery stent placement for atherosclerotic renal artery stenosis in patients with coronary artery disease.1998
Stent-supported angioplasty of severe atherosclerotic renal artery stenosis preserves renal function and improves blood pressure control: long-term results from a prospective registry of 456 lesions.2004
Evaluation of the safety and effectiveness of renal artery stenting after unsuccessful balloon angioplasty: the ASPIRE-2 study.2005
Delicate percutaneous renal artery stenting minimizes postoperative renal injury and protects kidney in patients with severe atherosclerotic renal artery stenosis and impaired renal function.2005
Renal function and outcome of PTRA and stenting for atherosclerotic renal artery stenosis.2003
Prospective evaluation of aggressive medical therapy for atherosclerotic renal artery stenosis, with renal artery stenting reserved for previously injured heart, brain, or kidney.2005
Clinical predictors of improved long-term blood pressure control after successful stenting of hypertensive patients with obstructive renal artery atherosclerosis.1999
Surgical management of atherosclerotic renovascular disease.2002
Medical versus surgical management of atherosclerotic renal artery stenosis.2002
Percutaneous and open renal revascularizations have equivalent long-term functional outcomes.2005
Percutaneous transluminal renal angioplasty (PTRA) and surgical revascularisation in renovascular disease--a retrospective comparison of results, complications, and mortality.2004
Baseline inflammatory status and long-term changes in renal function after percutaneous renal artery stenting: a prospective study.2013
Renal artery revascularization: outcomes stratified by indication for intervention.2009
Predictive role of renal resistive index for clinical outcome after revascularization in hypertensive patients with atherosclerotic renal artery stenosis: a monocentric observational study.2014
Roll-in experience from the Cardiovascular Outcomes with Renal Atherosclerotic Lesions (CORAL) study.2014

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