artery stenting in patients with atherosclerotic renal artery stenosis

(ARAS) and impaired renal function.

in patients with ARAS and impaired renal function.

and computer generated, and allocation was assigned by e-mail.

Patients, providers, and persons who assessed outcomes were not

blinded to treatment assignment.

or medical treatment only (76 patients). Medical treatment consisted

of antihypertensive treatment, a statin, and aspirin.

decrease in creatinine clearance. Secondary end points included

safety and cardiovascular morbidity and mortality.

the procedure. Ten of the 64 patients (16%) in the stent placement

group and 16 patients (22%) in the medication group reached the

primary end point (hazard ratio, 0.73 [95% CI, 0.33 to 1.61]).

Serious complications occurred in the stent group, including 2

procedure-related deaths (3%), 1 late death secondary to an infected

hematoma, and 1 patient who required dialysis secondary to

cholesterol embolism. The groups did not differ for other secondary

end points.

artery stenosis greater than 50% by noninvasive imaging and did

not ultimately require stenting.

effect on progression of impaired renal function but led to a small

number of significant procedure-related complications. The study

findings favor a conservative approach to patients with ARAS,

focused on cardiovascular risk factor management and avoiding

stenting.

and Pfizer.

For author affiliations, see end of text.

Clinicaltrials.gov registration number: NCT00150943.

* For a list of investigators, sites, and organization of the 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)

This article was published at www.annals.org on 5 May 2009.