Study finds stenting offers increased risk and no clear benefit compared to medication only
21 june 2009-- Stenting and medical treatment in the treatment of renal artery stenosis showed no benefit over medical treatment alone in a study reported in the June 16 issue of the Annals of Internal Medicine.
Liesbeth Bax, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues recruited 140 patients who had atherosclerotic renal artery stenosis and impaired renal function, of whom 64 received a stent plus medical treatment (antihypertensive treatment, a statin, and aspirin) and 76 received medical treatment only. The study end points included a ≥20 percent decrease in creatinine clearance (primary), and safety and cardiovascular morbidity and mortality (secondary).
Ultimately, only 46 of 64 patients in the study group received stents, the researchers found. At study end point, 10 of the 64 patients (16 percent) in the stent group and 16 patients (22 percent) in the medication-only group reached the primary end point of creatinine clearance (hazard ratio, 0.73). In the stent group, there were two procedure-related deaths and one late death from an infected hematoma.
"Stent placement with medical treatment had no clear 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 atherosclerotic renal artery stenosis, focused on cardiovascular risk factor management and avoiding stenting," the authors write.
The study was supported by Bayer, Cordis, and Pfizer. Several authors reported a relationship with the pharmaceutical industry.