In renal artery atherosclerosis, intensive medical management is the established first-line approach. When that regimen does not achieve the required blood pressure target, an alternative treatment pathway is indicated.
The prior regimen includes intensive antihypertensive therapy with renin-angiotensin-aldosterone system (RAAS) blockers — either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker — combined with a lipid-lowering statin, antiplatelet therapy with low-dose aspirin, tobacco cessation, and glycemic control.
Blood pressure was not controlled to the target of <130/80 mm Hg (systolic <120 mm Hg per KDIGO guidelines), triggering escalation to the next treatment step.
When blood pressure targets are not achieved with medical therapy, an endovascular procedure directed at the stenotic renal artery is considered. The complete protocol — including patient selection, procedural details, and monitoring — is available via the link below.
With the expansion of endovascular revascularization procedures in the 1980s, percutaneous angioplasty with stent implantation was later widely applied to ARVD, allowing treatment of individuals deemed to be at high surgical risk.
Large ARVD registries and cohort studies have suggested that patients with higher-risk clinical presentations such as AKI, acute and chronic HF, and rapidly declining kidney function, especially if accompanied by severe hypertension, are more likely to show a positive clinical outcome.
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