Levin Adeera, Linas Stuart, Luft Friedrich C, Chapman Arlene B, Textor Stephen
Denver Health Medical Center, Denver, Colo 80204, USA.
Am J Nephrol. 2007;27(2):212-20. doi: 10.1159/000101000. Epub 2007 Mar 21.
Renovascular hypertension is a recognized secondary potentially curable cause of hypertension since the work of Harry Goldblatt. Operative treatments for renal artery stenosis (RAS) have been offered for decades and percutaneous interventions have been widely available for 20 years. Stenting has largely obviated recurrence and modern techniques have contributed greatly to the safety of the procedure. Nevertheless, controversy abounds and prospective randomized trials have not successfully documented the value of intervention in patients with atherosclerotic RAS. The patient population has also changed remarkably. Whereas earlier patients with RAS were identified on clinical grounds, RAS is now commonly found serendipitously during angiography for other reasons. Whether or not these patients benefit from 'drive by' stenting is unknown. The practice may be hazardous and should be critically examined. A dialog and closer cooperation between cardiologists and nephrologists is warranted and organized programs should be formulated to address this problem.
自哈里·戈德布拉特开展相关研究以来，肾血管性高血压一直被认为是一种可治愈的继发性高血压病因。针对肾动脉狭窄（RAS）的手术治疗已开展数十年，经皮介入治疗也已广泛应用20年。支架置入术在很大程度上避免了复发，现代技术也极大地提高了该手术的安全性。然而，争议仍然很多，前瞻性随机试验尚未成功证明对动脉粥样硬化性RAS患者进行干预的价值。患者群体也发生了显著变化。早期RAS患者是通过临床检查确诊的，而现在RAS通常是在因其他原因进行血管造影时偶然发现的。这些患者是否能从“顺便”置入支架中获益尚不清楚。这种做法可能存在风险，应进行严格审查。心脏病专家和肾病专家之间需要进行对话并加强合作，应制定有组织的计划来解决这一问题。
