Chief Medical Editor's Page.
The Emergence of Renal Artery Stenting
AThe first successful balloon angioplasty of the renal artery was performed by Andreas Gruntzig, MD, and described in 1976. The first renal angioplasties in the US were performed by this author, as well as Drs. Tegtmeyer and Schwarten in the early years of balloon angioplasty.
Nearly a decade’s experience with renal artery stenting has demonstrated that stents can have the same benefits on acute revascularization of the renal arteries, as they do in virtually all other circulations. Improved acute outcomes and probable reduction in restenosis can be achieved, particularly when renal arteries are 6 mm or greater. Despite the improving techniques and efficacy of angioplasty and stenting, this procedure remains controversial, particularly among nephrologists, some of whom see little benefit to interventions outside of very narrow indications. In particular, the question of ?drive-by? or incidental screening for renal artery stenosis remains a persistent and important controversy.
It is reasonable to question the value of screening, if the value of therapy cannot be proven. The editors believe that detection of disease remains critical, particularly in patients who are already identified as having significant vascular pathology, either in the coronary, cerebral vascular, or peripheral vascular circulations, identification of renal artery stenosis can provide both a valuable assessment of the extent of disease, as well as a significant independent predictor of subsequent mortality.
The issue of therapy should be separated from screening, and should only be performed when clear cut clinical and measurable indications are present.
Similarly, renal artery stenting is associated with restenosis rates (approximately 20%) and clinical failure rates of at least the same degree. Therefore, intervention should be reserved for patients with clear-cut indications and predicted beneficial outcomes. A number of clinical trials important to our field are underway or being developed. Of all the areas of vascular disease, renal vascular disease has clearly been the least studied from a pure scientific point-of-view. Work being done by authors such as Drs. Andrew Holden, Christopher Cooper, and Tim Murphy to produce prospective controlled clinical trials will serve our patients as well as the clinical community.
We are fortunate to have contributions by authors who have impacted greatly on the field of renal vascular intervention. In this issue of Endovascular Today, Thomas A. Sos, MD, and David W. Trost, MD, have composed two outstanding articles on the importance of renal angioplasty and stenting in patients with ischemic nephropathy, and a comprehensive list of ?tips and tricks? for treating high-risk patients. Christopher J. White, MD, presents some of the common myths and facts surrounding renal artery stenting. Andrew Holden, MD, shares his initial experience using embolic protection in conjunction with renal angioplasty and stenting. Finally, Andrew B. Covit, MD, and Larry E. Shindelman, MD, illustrate the fact that one of the essential steps in providing the best, most appropriate treatment for patients suffering from renovascular disorders is ensuring that everyone in your referral base understands the warning signs and potential treatment options available.
We hope that regardless of your degree of experience in the field of renal artery stenting, you find this issue of Endovascular Today to be helpful and thought provoking in your efforts to elevate the standards of care.