This document discusses renal artery stenosis, its incidence, risks, and indications for revascularization. It provides details from clinical trials on revascularization including complications from the ASTRAL trial and outcomes from the STAR trial comparing revascularization to medical therapy. Indications for revascularization include resistant or accelerated hypertension, acute organ damage from hypertension, and asymptomatic renal artery stenosis meeting certain visual estimation or pressure gradient criteria. Factors that may argue against revascularization include proteinuria over 1g/day and severe renal parenchymal disease.

1. ESTENOSIS ARTERIA RENAL

2. • INCIDENCIA: 0.5-5%
• HTA REFRACTARIA: <10-15%
• MAYOR RX DE ACV, CCI Y SOBREVIDA MENOR

5. ASTRAL (ANGIOPLASTY
AND STENTING FOR RENAL ARTERY
LESIONS) TRIAL27

9. Serious
complications associated with revascularization occurred in 23 patients,
including
2 deaths and 3 amputations of toes or limbs.

10. STAR (STENT PLACEMENT AND BLOOD PRESSURE
AND LIPID-LOWERING FOR THE PREVENTION OF
PROGRESSION OF RENAL DYSFUNCTION CAUSED
BY ATHEROSCLEROTIC OSTIAL STENOSIS OF THE
RENAL ARTERY)

13. Undeniable indications for
revascularization
(Am Heart J 2009;158:154-62.)
(Am Heart J 2009;158:154-62.)

14. • Hemodynamically significant asymptomatic (incidental) RAS (is defined as:
1. 50% to 70% diameter stenosis by visual estimation with a peak translesional
gradient (measured with a ≤5F catheter or pressure wire) of 20 mm Hg or higher
or a mean gradient of 10 mm Hg orhigher; OR
2. any stenosis with 70% or larger diameter by visual estimation; OR
3. stenosis with 70% or larger diameter by intravascular ultrasound measurement

15. • HTA resistente: HTA CON TTO MAS DE TRES DROGAS A
DOSIS MAXIMA Q INCLUYE UN DIURETICO
• HTA ACELERADA: SUBITO Y RAPIDO DETERIORO.
• HTA CON DAÑO AGUDO DE UN ORGANO: IRA,
INS CARD AGUDA; NUEVo DISTURBIO NEUROLOGICO U
OFTALMOLOGICO .Y /O GRADO IIi/IV DE RETINOPATIA.

16. • noted that the National Kidney Foundation defines chronic kidney disease
as a decrease in estimated glomerular filtration rate to less than 60
mL/min per 1.73 m2 (modified Modification of Diet in Renal Disease
formula) that persists for at least 3 months
• Studios with a baseline serum creatinine between 1.5 and 4.0 mg per dL
(751).
• Several factors may argue against
– proteinuria greater than 1 g every 24 hours renal atrophy,
– severe renal parenchymal diseas disease, and severe diffuse
– intrarenal arteriolar disease.
• renal function can deteriorate after renal arteryangioplasty, especially in
patients with stable renal functionprior to the intervention

17. Referencias
• Atherosclerotic renal artery stenosis: Current therapy
and future developments Am Heart J 2009;158:154-62
• Management of Renal Artery Stenosis Progress in
Cardiovascular Disease 52 (2009) 229–237
• Primary stenting for atherosclerotic renal artery
stenosis J Vasc Surg 2010;51:1574-80.)
• STAR Revascularization versus Medical Therapy for
Renal-Artery Stenosis N Engl J Med 2009;361:1953-62.
• RAS renal function: a randomized trial. Ann Intern Med
• 2009;150:840-8.