Severe Renal Artery Stenosis

Patients with uncontrolled renovascular hypertension despite maximal medical therapy, ischemic nephropathy, and cardiac destabilization syndromes who have hemodynamically obstructive renal artery stenosis are likely to benefit from renal artery stenting. Screening for renal artery stenosis can be done with Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography. Currently the technical success for renal stenting (>97%) exceeds the percentage (similar to 70%) of patients benefitting from the procedure. Physiologic measurements such as hyperemic/resting translesional gradients are useful to confirm the severity of renal hypoperfusion and therefore improve the selection of patients likely to respond to renal artery revascularization. Experienced operators should perform renal interventions in order to minimize complications. Radial access should be preferred to avoid access related complications. Primary patency of well-placed bare metal stents exceeds 80% at five years and surveillance for in-stent restenosis can be done with periodic clinical, laboratory, and imaging follow-up.