Editorial Comment: Renal stenting: still alive after ASTRAL and STAR publications?

Renal artery stenosis may cause systemic hypertension and renal failure (1, 2) and is associated with increased cardiovas- cular morbidity and mortality (3, 4). Renal obstruction is a rela- tively frequent finding in patients with diffuse atherosclerosis. Indeed, among patients undergoing coronary angiography, the prevalence of renal stenosis is reported to be between 11% and 23% (7). Renal stenting has been associated with improved blood pressure control and stabilized or improved renal function (5, 6), thus it represents an accepted treatment for patients with renal artery stenosis and severe hypertension and/or renal insufficiency (8). In the retrospective study published in the current issue of the journal, Dervişoğlu et al. (9) report the effects of renal stenting on both renal function and blood pressure control in 36 patients treated on 43 arteries at 9.3+8.6 months follow-up. Despite the adoption of a relatively outdated technique (7 Fr guiding catheters, 0.018 hand-crimped stents), the authors achieved excellent imme- diate results with no major procedural complications. They found a significant improvement in blood pressure control with a reduc- tion of both the mean arterial blood pressure (MABP) (from 123±22 mmHg pre-procedure to 101±14 mmHg at follow-up (p 0.001)) and the number of antihypertensive medications (from 2.1±1.0 (range, 0-4) pre-procedure to 1.3±1.0 (range, 0-4) at follow-up (p .001)). Moreover, regarding renal function, although no significant change in estimated glomerular filtration rate (EGFR) from pre-procedure to follow-up (71.4±40.2 mL/min vs.73.3±39.0 mL/min; p=0.483) was documented, in the group of patients with renal impairment (EGFR ≤ 59 mL/min), 41% showed improvement, 29% showed no change and 29% demonstrated deterioration in EGFR.