Endovascular intervention for renal artery occlusive disease

Historically, renal artery (RA) stenosis has been regarded as the most common curable cause of secondary hypertension. The rationale for intervention was based on stabilization of the renin-angiotensin pathway that is artificially elevated or theoretically accelerated when a kidney is exposed to decreased blood volume secondary to RA stenosis. Recent trials have cast doubt on both this pathway and its influence on patients with hypertension. The high incidence of essential hypertension in the atherosclerotic patient population further confuses the question of the impact of RA stenosis on this pathology. Considering 15% of patients undergoing coronary angiography are found to have a >50% stenosis of the RAs, blanket statements connecting RA stenosis and hypertension seems unwarranted. Putative benefits of renal parenchymal preservation in the face of RA stenosis are even more controversial. Thus, current evidence suggests that the medical field is at a point of change regarding both open and endovascular RA intervention for stenosis.