Abstract 4179: Percutaneous Revascularization versus Medical Therapy Alone to Treat Renal Artery Stenosis: A Meta-Analysis
Background: Patients with renal artery stenosis are treated with percutaneous intervention, but pertinent randomized studies are still inconclusive. We conducted a systematic review and meta-analysis of randomized trials comparing renal percutaneous revascularization (renal artery angioplasty with or without stenting) versus medical therapy.
Methods: Pertinent studies in were systematically searched, appraised and abstracted, yielding three randomized studies comparing renal angioplasty versus medical therapy, and two randomized studies comparing renal angioplasty with stenting versus medical therapy in patients with atherosclerotic renovascular disease. Six sets of data (one study analyzed unilateral and bilateral renovascular disease separately) were then extracted focusing on serum creatinine, systolic and diastolic blood pressure at follow-up.
Results: The five trials included 984 patients with renal artery stenosis (480 treated with renal artery angioplasty with or without stenting). Overall, there was no significant difference between renal artery percutaneous intervention versus medical therapy when evaluating renal function at follow-up intervals from 3 to 24 months. The serum creatinine was not significantly different in the patients who underwent percutaneous intervention compared to the medical therapy group (weighted mean difference [WMD] 0.64 mmol/L, 95% confidence interval [CI] (−1.04) – 2.31; P=0.45). However, the systolic blood pressure was significantly improved in the group undergoing percutaneous revascularization (WMD -3.23 mmHg, CI −8.18 – (−0.27); P=0.03), while diastolic pressure was not changed (WMD 0 mmHg, CI (−0.4) - 0.4; P=0.9).
Conclusions: This meta-analysis of renal artery intervention trials does not show an improvement in renal function but shows an improvement in systolic blood pressure at 3–24 months follow-up in patients with renal artery stenosis treated with renal artery revascularization compared to medical therapy alone. The clinical implications of these findings are that the indications for percutaneous renal intervention need to focus predominantly on the treatment of renovascular hypertension and less on the salvage of renal function.