Renal Artery Stenosis: Percutaneous Revascularization or Medical Therapy?

Renal artery stenosis (RAS) is caused by atherosclerosis in 90% of the cases while it is related to fibromuscolar dysplasia in almost 10% of the cases. RAS may cause malignant hypertension and reduction of kidney function. Therefore it is important to carry out an optimal therapy to reduce complications. There is general agreement on the efficacy of a strict medical therapy. On the contrary, the usefulness of a contemporary percutaneous revascularization intervention to ameliorate BP and GFR is questionable. Thus we searched the literature using PubMed by entering the search terms “renal artery stenosis, atherosclerotic renal artery stenosis, renovascular hypertension”. In this review we analyze the epidemiology, physiopathology, diagnosis and, in particular, the different treatment options on the basis of the more recent clinical trials.