Comparative Effectiveness of Management Strategies for Renal Artery Stenosis: 2007 Update: Comparative Effectiveness Review Number 5 Update

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Overview

This report is an update to a Comparative Effectiveness Review on management strategies for renal artery stenosis (RAS) from October 2006. The systematic review included all studies of patients with atherosclerotic RAS (ARAS) that compared two or more interventions. It also reviewed recent prospective cohort (single arm) studies of angioplasty with stent placement, prospective cohort studies of medical interventions, cohort studies of RAS natural history, and prospective or large retrospective studies of surgical bypass. This update evaluated the same questions and used the same eligibility criteria, updating the literature search through April 23, 2007. The Key Questions addressed by the original report and this update are: 1. For patients with atherosclerotic renal artery stenosis in the modern management era (i.e., since JNC-5 in 1993i), what is the evidence on the effects of aggressive medical therapy (i.e., antihypertensive, antiplatelet, and antilipid treatment) compared to renal artery angioplasty with stent placement on long-term clinical outcomes (at least 6 months), including blood pressure control, preservation of kidney function, flash pulmonary edema, other cardiovascular events, and survival? 1a. What are the patient characteristics, including etiology, predominant clinical presentation, and severity of stenosis, in the studies? 1b. What adverse events and complications have been associated with aggressive medical therapy or renal artery angioplasty with stent placement? 2. What clinical, imaging, laboratory, and anatomic characteristics are associated with improved or worse outcomes when treating with either aggressive medical therapy alone or renal artery angioplasty with stent placement? 3. What treatment variables are associated with improved or worse outcomes of renal artery angioplasty with stent placement, including periprocedural medications, type of stent, use of distal protection devices, or other adjunct techniques?