Clinical implications, technique and outcome of endovascular treatment of renal artery stenosis.

Renal artery stenosis (RAS) may cause or deteriorate arterial hypertension and/or renal insufficiency. Moreover, RAS seems to affect structural heart disease. Technical improvements of diagnostic and interventional endovascular tools have led to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy. Since the first renal artery angioplasties performed by Mahler and Grüntzig in 1978, mostly single center studies have reported in the majority of patients beneficial effects of percutaneous transluminal renal angioplasty, and since the early 1990's of stenting RAS. Due to reports upon post procedural impairment of renal function in a reasonable number of patients, the role of protection devices has been raised recently. This article summarizes the current technique of endovascular treatment of RAS and the clinical impact on blood pressure control, renal function, and structural heart disease. The results discussed are based mainly on registry data because randomized studies comparing stent-supported angioplasty with best medical therapy are still missing.