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Revascularization in Renovascular Disease Studied

ASTRAL investigators find no benefit to renal function and substantial complication risk

WEDNESDAY, Nov. 11 (HealthDay News) -- Revascularization through angioplasty and stenting does not significantly improve renal function in patients with atherosclerotic renovascular disease compared to medical therapy alone, according to a study in the Nov. 12 issue of the New England Journal of Medicine.

The Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) investigators randomized 806 patients who had atherosclerotic renovascular disease to receive either medical therapy only (statins, antiplatelet agents and blood pressure control) or medical therapy plus angioplasty (and stenting, as appropriate). The researchers monitored renal function as indicated by serum creatinine level. Among secondary outcomes monitored over a median 34 months of follow-up were mortality, time to renal and major cardiovascular events, and blood pressure.

The researchers found that the rate of renal impairment progression was slightly less in the revascularization group by 0.06x10−3 liters per micromole per year (the slope of the reciprocal of the serum creatinine level), a reduction not considered clinically significant. Results were similar in both groups for mortality and rates of renal and major cardiac events. Meanwhile, 23 patients suffered complications associated with revascularization, which included two deaths and three amputations.

"In summary, we compared endovascular revascularization plus medical therapy with medical therapy alone in patients with atherosclerotic renovascular disease. Revascularization carried substantial risk but was not associated with any benefit with respect to renal function, blood pressure, renal or cardiovascular events, or mortality," the authors write.

Several study authors reported receiving consulting and speaker fees and research and educational grants from pharmaceutical companies.

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