EMMA |
26 controls |
> 75% unilateral |
SCr CrCl |
Angioplasty, two patients
stented |
ACEi |
23 cases |
CrCl ≥ 50 |
SNRASCG |
30 controls |
> 50% unilateral or
bilateral |
SCr |
Angioplasty |
ACEi |
25 cases |
Cr < 5.6 |
DRASTIC |
50 controls |
> 50% unilateral or
bilateral |
SCr |
Angioplasty, two patients
stented |
ACEi Statins |
CrCl |
56 cases |
Cr < 2.3 |
STAR |
76 controls |
> 50% unilateral or
bilateral |
SCr |
Angioplasty, 46 patients
stented |
ACEi Statins |
CrCl |
64 cases |
CrCl < 80 |
ASTRAL |
403 controls |
> 50% unilateral or
bilateral |
Inverse creatinine slope 22% with
CrCl < 25 |
Angioplasty with stenting in 95%
of the patients |
ACEi (more in the case group)
Statins |
403 cases |
CORAL |
472 controls |
> 80% unilateral or bilateral |
CrCl. |
Angioplasty with stenting in 95%
of the patients |
ARBs Statins |
Between 60-80% with at least 20
mm Hg systolic pressure gradient |
459 cases |
|
Exclusion criteria
|
Primary endpoint
|
Complications
|
Conclusion
|
EMMA |
Malignant hypertension stroke,
APE, MI within the last six months, DBP > 109 despite treatment |
BP at the end of follow-up |
Three cases of restenosis, one
dissection with segmental infarction |
Angioplasty allowed better
short-term BP management, but was associated with more complications in
patients with unilateral ARAS |
SNRASCG |
Patients under 40
years; stroke or MI within the last three months |
Differences in BP
and serum Cr between baseline and six months into follow-up |
Eight patients with
puncture site bleeding; two referred to RRT |
BP was not statistically
different after six months. |
No differences seen in serum
creatinine levels |
DRASTIC |
Cancer, hypertension secondary
to other diseases, unstable coronary disease, CHF, pregnancy |
SBP and DBP three and 12 months
after randomization |
Two cases of cholesterol
embolism; six cases of hematoma requiring blood transfusion |
BP levels in the third and tenth
months were not significantly different. In the third month, CrCl was
higher in the angioplasty group, but on twelfth month the difference
disappeared |
STAR |
Kidney < 8 cm Renal artery
diameter < 4 mm. CrCl < 15 DM with proteinuria > 3 g/24h
malignant hypertension |
Decrease greater than 20% on
CrCl |
Two procedure-related deaths;
17% had puncture site hematomas; one patient referred to RRT |
No differences on primary
endpoint. Grups had similar survival |
ASTRAL |
Need for surgical
revascularization; |
Renal function
alteration by inverse creatinine slope |
38 complications in
31 of the 359 patients offer angioplasty (9%); 19 severe events |
No differences seen
in renal function progression |
non-atheromatous disease; |
previous revascularization for
renal artery stenosis |
CORAL |
Need for surgical
revascularization; |
Major cardiovascular
or renal event; death for cardiovascular or renal causes; stroke; MI;
hospitalization for CHF; deteriorating renal disease; need for permanent
RRT |
Arterial dissection
in 11 patients |
Angioplasty with
stenting did not offer additional benefits versus
optimized drug therapy for patients with ARAS, SH, or CKD |
fibromuscular dysplasia; |
Cr > 4.0; |
Kidney < 7 cm; |
stenosis not treatable with one
stent |