To Stent or Not to Stent? This is the Renal Artery Stenosis Question

A few days ago (Nov 18, 2013) the results of the large prospective were presented and published. CORAL enrolled 947 participants who had atherosclerotic renal artery stenosis (ARAS), 60% and either uncontrolled systolic hypertension despite treatment with 2 anti-hypertensive drugs or stage 3 chronic kidney disease (CKD) [1]. CORAL randomly assigned patients to medical therapy plus renal-artery stenting or medical therapy alone. The median follow-up period was 43 months and the primary endpoint was a composite of death from cardiovascular disease (CVD) or renal causes, myocardial infarction (MI), stroke, congestive heart failure, progression of renal insufficiency, or need for renal replacement therapy. Results showed that the addition of renal-artery stenting to thorough multifactorial medical therapy did not contribute a significant clinical benefit with respect to the prevention of CVD events or renal function deterioration. Adverse CVD or renal events occurred in 35.1% of patients who received stenting and 35.8% of those on medical therapy alone (p=0.58) [1]. Thus, the authors concluded that renal artery stenting was not superior to optimal medical therapy alone for moderately severe ARAS [1].