Benefits Low for PTRAS vs Medical Therapy in Renal Artery Stenosis
Low evidence for benefits, harms of percutaneous transluminal renal angioplasty with stent placement.
(HealthDay News) -- For patients with atherosclerotic renal artery stenosis (ARAS), the strength of evidence for the relative benefits and harms of percutaneous transluminal renal angioplasty with stent placement (PTRAS) versus medical therapy alone is low, according to a review published online in the Annals of Internal Medicine.
Gowri Raman, MD, from the Tufts Medical Center in Boston, and colleagues conducted a systematic literature review to compare benefits and harms of PTRAS versus medical therapy alone in adults with ARAS. Data were included for 83 studies which met the eligibility criteria.
The researchers found that in 5 of 7 randomized controlled trials (RCTs), there was similar blood pressure (BP) control with PTRAS and medical therapy in patients with ARAS; there were no significant differences in kidney function, mortality, renal replacement therapy (RRT), cardiovascular events, or pulmonary edema in RCTs. More variable results were seen in 8 nonrandomized comparative studies, mostly showing no significant differences in mortality, RRT, or cardiovascular events, but heterogeneous effects were seen on kidney function and BP. Adverse events related to procedure were rare, and there were no reports of medication-related adverse events. No patient characteristics that were associated with outcomes for PTRAS or medical therapy were found in 2 RCTs; various but inconsistent factors that predict outcomes were identified in single-group studies.
"The strength of evidence regarding the relative benefits and harms of PTRAS versus medical therapy alone for patients with ARAS is low," the authors write.
1. Raman G, Adam, Halladay CW, Langberg VM, Azodo IA, and Balk EM. Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: An Updated Systematic Review. Ann Intern Med. Published online 2016 16 Aug doi:10.7326/M16-1053.