ArticleKidney medicine2026
Patient Selection for Revascularization of Atherosclerotic Renal Artery Stenosis: Comparing the Importance of Stenosis Severity and Clinical Phenotype.
Article in Kidney medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Rationale & Objective: Trials failed to show that angioplasty and stenting of atherosclerotic renovascular disease (ARVD) conferred benefit when used as first-line therapy. However, some patients might benefit from kidney revascularization depending on their clinical phenotype and severity of renal artery stenosis (RAS). We investigated this hypothesis further. Study Design: Data from the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) randomized trial and Salford ARVD observational study were included in a single analysis. Setting & Participants: Patients were grouped based on RAS severity (≥70%) and whether unilateral or bilateral, with the bilateral group including RAS in a single functioning kidney. High-risk clinical phenotypes included advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m Exposures: Medical therapy alone versus medial therapy and kidney revascularization. Outcome: Composite of end stage CKD, cardiovascular events, or all-cause mortality. Analytical Approach: Cox proportional hazard model adjusted for age, self-reported gender, and estimated glomerular filtration rate. Analysis of all patients and selected subgroups. Results: In total, 1,644 patients (806 ASTRAL and 838 Salford). Median (IQR) age 72 (66-77) years. For bilateral severe RAS (≥70%) the HR for the composite outcome for revascularization compared with medical therapy was 0.70 (0.50-0.99), Limitations: The analyses included observational data. Conclusions: The presence of bilateral severe RAS may be the best predictor of benefit for kidney revascularization.
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