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Renal Artery Stents Lead To Similar Outcome vs. Medication-Only


The narrowing and hardening of one or both renal arteries, known as renal artery stenosis, occurs in 1 to 5% of people who have high blood pressure, or hypertension. An estimated 78 million Americans have hypertension, according to the AHA, and as many as 3.9 million people in the United States may have renal artery stenosis. Renal artery stenosis can lead to conditions such as chronic kidney disease and can appear alongside conditions including coronary artery disease. Effective treatment of renal artery stenosis can improve blood pressure control, stabilize kidney function, and reduce incidence of serious cardiovascular events.


According to the study’s authors, between 1996 and 2000, there was a 364% jump in renal artery stenting procedures for Medicare beneficiaries. The procedure involves inserting a metal mesh tube into an artery to open the clogged passageway. Now, according to findings that were presented last week at the American Heart Association (AHA) 2013 Scientific Sessions in Dallas, a commonly used stenting procedure to treat plaque build-up in the renal artery appears to offer no significant improvement when added to medication-based therapy.


The Cardiovascular Outcomes in Renal Atherosclerotic Lesions study, known as CORAL, studied 947 patients whose plaque build-up in the renal artery narrowed the blood vessel by 60% or more. Participants, whose average age was 69 years, had renal artery stenosis and either systolic blood pressure of 150 mmHg or higher while taking two or more drugs or Stage 3 (moderate) chronic kidney disease. Researchers from more than 100 institutions randomly assigned participants to receive medical therapy only or medical therapy plus a stent. The research team examined the effect of the two treatment options on a combination of cardiovascular and renal outcomes that included death from renal or cardiovascular causes; heart attack; hospitalization for congestive heart failure; progressive renal insufficiency; or renal replacement therapy, which includes the need for dialysis or renal transplantation. Results showed that during an average follow-up period of 43 months, 35.1% of patients who received medical therapy and stents experienced one of the negative endpoints versus 35.8% of patients who received medication alone.


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