Case Against Angioplasty and Stenting of Atherosclerotic Renal Artery Stenosis

Atherosclerotic renal artery stenosis (RAS) is a relatively common problem, estimated to affect between 1% and 5% of patients with hypertension.1,2 Given the high prevalence of hypertension, it follows that there are from 2 million to 4 million individuals with RAS in the United States alone. A challenging feature of the disease is the high incidence of adverse cardiovascular events in affected individuals compared with those with normal renal arteries, which also presents a potential opportunity. On the one hand, there may be such a large burden of atherosclerotic disease by the time patients present that it is too late for an intervention in a single vascular bed to significantly alter outcomes. On the other hand, it is possible that an effective intervention might reduce adverse events, which has led some physicians to take an aggressive approach to diagnosing and correcting RAS.