Stent placement for renal artery stenosis : functional aspects and morphologic intravascular ultrasound parameters that define clinical success

Obstruction of the renal arteries (renal artery stenosis, RAS) is a frequent entity with reported incidence of up to 53% in autopsy studies in unselected subjects. RAS most often occurs in the context of systemic atherosclerosis and is then associated with plaque accumulation in the intimal layer of the renal artery wall. Less frequently, RAS may be associated with other diseases such as fibromuscular dysplasia, Takayasu's arteritis and neurofibromatosis, or with aortic coarctation. In many vascular territories without abundant collateral circulation, interruption of the supply of oxygen to the target tissue because of arterial stenosis causes symptoms of ischemic pain. In RAS, however, ischemic pain is not a prominent feature. RAS may present clinically with systemic hypertension, renal functional impairment but more often, RAS remains asymptomatic. In asymptomatic patients RAS is often found incidentally whenever angiograms are made for other purposes. It is open to debate whether patients with asymptomatic RAS should undergo revascularization of the renal artery. It has been argued, e.g .. that the disease is progressive in severity over time and that revascularization is indicated to prevent the future development of end-stage renal failure. On the other hand, it is at present unknown whether RAS, if left untreated in these asymptomatic patients, will truly lead to clinical symptoms that make prophylactic revascularization worthwhile.

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