November 12th, 2009
No Clinical Benefits of Revascularization in Atherosclerotic Renal Arteries
Larry Husten, PHD
Revascularization for atherosclerotic renovascular disease, performed in over 15% of such patients in the U.S., shows “no evidence of a worthwhile clinical benefit,” according to a New England Journal of Medicine study.
The ASTRAL investigators studied outcomes in some 800 patients, half of whom had been randomized to undergo revascularization in addition to receiving usual medical therapy. After a median follow-up of almost 3 years, there was less deterioration in renal function among those who underwent revascularization. However, the authors say the benefits “were below levels that would be considered clinically relevant.”
No improvements in blood pressure, or reductions in renal or cardiovascular events or mortality were seen with revascularization. On the other hand, the procedure was associated with severe complications.
One of the main limitations of their study, the authors say, is that they excluded people with severe renal artery stenosis who, in their doctors’ opinion, required revascularization, yet they point out that “the widespread use of such procedures outside of clinical trials can now be questioned.”
