The future of renal artery stenting

Interv. Cardiol. (2014) 6(2), 127–129 ISSN 1755-5310 The future of renal artery stenting for atherosclerotic renal artery stenosis Recently, the CORAL trial was published [1]. The overall finding of the CORAL trial was that stenting of atherosclerotic renal artery stenoses did not reduce the composite end point of cardiovascular or renal death, myocardial infarction, stroke, congestive heart failure hospitalization, progressive renal insufficiency, or the need for renal replacement therapy. This study is the most recent of several randomized trials to look at renal artery revascularization [2–6], all of which have been negative. Many of the prior trials faced criticism due to perceived limitations in trial size, design or conduct. The earliest of these studies (EMMA, the Scottish and New Castle trial and DRASTIC) [2–4] were limited by small size and a predominant use of angioplasty without stenting. The more recent of these trials, STAR and ASTRAL [5,6], may have been limited by other methodologic issues such as inclusion criteria and the lack of core lab analyses. These limitations have been pointed out in many prior publications, perhaps most famously in an editorial by Christopher White [7]. However, with the consistently negative outcomes of all the randomized studies of renal artery revascularization, there should be little debate that renal artery revascularization has a very limited, if any, role in the management of atherosclerotic renal artery stenosis.