关键字：CARI指南,肾动脉狭窄,renal artery stenosis (RAS),
a. Correction of renal artery stenosis (RAS), either by revascularisation surgery or percutaneous methods, has been shown to be effective in treating hypertension associated with renal artery stenosis. (Level II evidence)
b. Balloon angioplasty has not been shown to be superior to medical management for preserving renal function in patients with RAS.
(Level I evidence)
c. Balloon angioplasty has not been shown to be superior to angioplasty with stenting for preserving renal function in patients with renal artery stenosis. (Level II evidence - multiple studies)
d. Balloon angioplasty has not been shown to be superior to surgical management in experienced centres for preserving renal function in patients with renal artery stenosis. (Level II evidence - one RCT)
(Suggestions are based on Level III and IV evidence)
· In the absence of trials showing benefit from revascularisation over conventional therapy and the significant risk of complications it seems reasonable to restrict procedures to patients who fail medical therapy with resistant or poorly-controlled hypertension; recurrent flash pulmonary oedema; dialysis-dependent kidney failure resulting from renal artery stenosis; chronic renal insufficiency and bilateral renal
artery stenosis; or renal artery stenosis to a solitary functioning kidney.
· In the absence of significant differences in long-term outcome measures, given the rates of restenosis following simple balloon angioplasty and the complications and costs of surgical intervention, it would seem reasonable to consider angioplasty with stenting as the revascularisation procedure of choice for medically recalcitrant renal artery stenosis. (Level IV evidence)
· The above clinical guidelines refer to patients with significant de novo renal artery stenosis (generally more than 50%–80% reduction in luminal diameter). There have been no studies in patients identified with lesser degrees of stenosis. It seems reasonable to offer medical therapy in these individuals, given the natural history of progressive stenosis in atherosclerotic renal disease.