Management of renal artery stenosis: the case for intervention, defending current guidelines, and screening (drive-by) renal angiography at the time of catheterization.

There is little debate that an untreated significant obstruction of blood flow to the kidney, most often due to atherosclerosis, is potentially hazardous to the health of patients. The treatment of atherosclerotic renovascular disease has evolved over the past 20 years from open surgery with its inherent morbidity and risk of mortality to percutaneous endovascular treatment with stents. The current debate is on the question of which patients are offered any additional advantage by revascularization for renal artery stenosis over medications alone. The primary issue is patient selection, including the most appropriate screening strategies for renal artery stenosis, which must be balanced against the risk of procedure-related complications. The goal of this paper is to explore the most appropriate utilization of revascularization with renal stent placement.