Atherosclerotic renal-artery stenosis is common among patients with cardiovascular disease and the condition may contribute to hypertension. The impact of renal artery angioplasty or stenting on the risk of clinical events among patients with atherosclerotic renal disease remains poorly defined. In the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study, 947 patients atherosclerotic renal-artery stenosis and hypertension and/or chronic kidney disease were randomized to medical therapy alone or medical therapy plus renal artery stenting.  The primary composite end-point included cardiovascular and renal death, myocardial infarction, stroke and progressive renal failure.  Over a median follow-up of 43 months, there was no difference in the rate of the composite outcome in patients treated with renal artery stenting compared with medical therapy alone (35.1% vs. 35.8%,; hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.76 to 1.17; P=0.58).  Further, individual components of the composite end-point were similar for both treatment groups.

Conclusions

In this large randomized trial, renal artery stenting for atherosclerotic stenosis failed to demonstrate clinical benefit.  These findings call into question a commonly performed, invasive, and costly procedure for patients with renal-artery atherosclerotic stenosis and suggest similar outcomes can be obtained with optimal medical management.

Summarized by Steven M. Bradley and Hussain Contractor

• Cooper CJ1, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM, Cohen DJ, Matsumoto AH, Steffes M, Jaff MR, Prince MR, Lewis EF, Tuttle KR, Shapiro JI, Rundback JH, Massaro JM, D’Agostino RB Sr and Dworkin LD.  Stenting and medical therapy for atherosclerotic renal-artery stenosis.  N Engl J Med. 2014 Jan 2;370(1):13-22.