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[Management of atherosclerotic renal-artery stenosis in 2016].

Authors
  • Fournier, Thomas1
  • Sens, Florence2
  • Rouvière, Olivier3
  • Millon, Antoine4
  • Juillard, Laurent5
  • 1 Service de néphrologie, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France. Electronic address: [email protected] , (France)
  • 2 Service de néphrologie, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Pôle IMER, site Lacassagne, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France. , (France)
  • 3 Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Service d'imagerie vasculaire et urinaire, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France. , (France)
  • 4 Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Service de chirurgie vasculaire, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France. , (France)
  • 5 Service de néphrologie, hôpital Édouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; OPeRa, Carmen, université Lyon 1, 11, avenue Jean-Capelle, 69621 Villeurbanne cedex, France. , (France)
Type
Published Article
Journal
Nephrologie & therapeutique
Publication Date
Feb 01, 2017
Volume
13
Issue
1
Pages
1–8
Identifiers
DOI: 10.1016/j.nephro.2016.07.450
PMID: 27887845
Source
Medline
Keywords
License
Unknown

Abstract

Endovascular revascularization as treatment of atherosclerotic renal-artery stenosis (aRAS) is controversial since 3 large and multicentric randomised trials (CORAL, ASTRAL, STAR) failed to prove the superiority of percutaneous transluminal renal-artery stenting (PTRAS) over medical treatment only (MT). However, considering the multiple bias of these trials, among which questionable inclusion criterias, these results must be extrapolated in clinical practice with caution. New pathophysiological data have been helping to understand why restoring blood flow does not necessarily lead to kidney function improvement. Today, the diagnostic approach must in one hand confirm the artery stenosis and on the other hand assess its severity and impact on the kidney. Therapeutic options still lie on the American guidelines published in 2006, since no study data can be reasonably used in everyday practice. However, particular sub-groups of patients who could benefit from revascularisation have been identified through recent cohort studies. Further prospective studies are needed in order to confirm the superiority of PTRAS in these populations. Meanwhile, multidisciplinary approach should be promoted, in order to provide the best treatment for each patient.

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