Is there still a role for renal artery stenting in the management of renovascular hypertension – A single-center experience and where do we stand?

Renal artery (RA) stenosis has been implicated in the pathophysiological mechanism for resistant hypertension. Despite the increasingly diagnosed frequency of hemodynamically significant lesions, the value of RA revascularization remains controversial. Our group had previously demonstrated significant blood pressure (BP) reduction in a retrospective cohort of appropriately selected patients undergoing RA stenting up to 18-months of follow-up. We herein present long-term clinical outcomes data 5-years post revascularization on 26 subjects who continued follow-up at our institution. Retrospective analysis was performed on subjects who underwent RA stenting at our institution for hemodynamically significant (≥70%) RA stenosis and systolic hypertension on ≥3 antihypertensive agents. Clinical outcome data for systolic blood pressure (SBP), diastolic blood pressure (DBP), creatinine level and number of antihypertensive drugs was assessed prior to and then later at 6–12 months and 3–5 years post RA stenting. Mean age was 69 ± 9 years; 27% (7/26) were male. Median follow-up was 5.1 years. Blood pressure reduction was sustained at long-term follow-up (135/70 ± 18/11 mmHg) compared to initial reduction noted at 6-months (136/69 ± 16/8 mmHg; p ≤0.01 for both) and from baseline (162/80 ± 24/18 mmHg; p ≤0.001 for both). The number of antihypertensive agents also decreased from 4.1 ± 1.0 to 2.7 ± 2.1 (p = 0.002) at 6-months and was sustained at long-term follow-up, 3.4 ± 1.2 (p = 0.03) with no difference in renal function between short- and long-term follow-up compared to baseline. This study shows sustained benefit of RA stenting in BP reduction in an appropriately selected cohort with significant stenosis ≥70% and uncontrolled hypertension on multiple medications on long-term follow-up. •Atherosclerotic renal artery stenosis (ARAS) is the leading cause of secondary hypertension.•There remains an unmet need for blood pressure optimization in patients with ARAS despite being on optimal medical regimen.•Multiple RCT's have failed to show any substantial benefit of renal artery stenting but have been criticized for appropriate patient selection.•Renal artery stenting in carefully selected 'real life' patients with uncontrolled hypertension can potentially provide long term sustained blood pressure reduction.•Large RCT’s are warranted to prove benefit of renal revascularization in high-risk patients and overcome the short-comings of earlier studies.