Renal artery stenting may benefit patients with renal artery stenosis (RAS) who have historically been excluded from modern clinical trials, according to a consensus statement issued by the Society for Cardiovascular Angiography and Interventions (SCAI).
The recent Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial failed to demonstrate benefit from renal stenting over optimal medical therapy, but patients whose condition might be improved by stenting were excluded from the trial.
The recommendations, which are contained in a paper titled, “SCAI Expert Consensus Statement for Renal Artery Stenting Appropriate Use,” have been published online in Catheterization and Cardiovascular Interventions. The recommendations are based on an expert panel review of scientific data.
The document recommends that patients most likely to benefit from renal artery stenting are those with cardiac disturbance syndrome or “flash” pulmonary edema; patients whose high blood pressure (BP) has not been controlled by 3 or more medications at maximal tolerated doses; and those with blockages in both kidneys or severe blockages in a single functioning kidney where BP or renal dysfunction cannot be managed medically.
“The CORAL trial answered many of our questions about renal artery stenting, but some patients who are seeking treatment today were not included in CORAL, including patients in whom optimal medical therapy failed,” the paper’s lead author, Sahil A. Parikh, MD, said in an SCAI press release. “The new recommendations were developed to help physicians evaluate treatment options for the broad range of patients with renal artery disease.”
Dr. Parikh is assistant professor of medicine at Case Western Reserve University School of Medicine and director of the Interventional Cardiology Fellowship Program at University Hospitals Case Medical Center, Cleveland.
According to the expert panel, patients with mild or moderate blockages (less than 70%), those with long-standing loss of blood flow and those with complete blockage of the renal artery are typically not good candidates for renal artery stenting. Whether renal artery stenting can improve symptoms in patients with heart failure over the long term is unknown.
The consensus statement also reviews the evidence and expert opinion on the performance of renal artery angiography and intervention with stents. The panel discusses the best practices for assessing arterial narrowing that is intermediate (50%–70%), which often does not limit blood flow.