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It is heard loud and clear ! Death knell for routine stenting for renal artery stenosis !

Posted Aug 31 2010 11:17am

For medical science  to  defy   logic , is a not a great  new discovery . “Diabetes is a major  risk factor for heart disease   but controlling diabetes may not  remove this risk factor” Similarly  severe mulitvessel CAD  occurs without  any symptoms and compromise on LV function . It is a natural human  instinct  to open of  any thing  that is obstructing   on  their  path . The same logic applies in   physicians when we encounter blocks in the vascular highways  .

For a moment compare  it with an express way .

We realise many  roads have a  reserve capacity . Even if the road is  half  blocked , traffic  congestion  rarely happens  as the  original road’s width is  sufficiently  large for the projected traffic . Some other roads have emergency  service lanes (Collaterals) that can take care the flow of traffic.

Another  question to ask is , Where does the road  lead to ? and why  we are  traveling ?

If it leads to a “dead  sea”  or a “bottom less cliff’  there is no purpose  to travel further . Similarly , when you find a destructed kidney with little nephron mass( or dead myocardium  ) there is absolutely no purpose  in opening the block . (Some  may  believe  the act  of  opening  block , by itself   is a success /  sorry- story !)

This is what happened in the lase decade . Interventional    radiologists , vascularologists , cardiologists started  opening  renal artery obstructions , at their whims and fancies, in  many elderly and middle-aged population .To their surprise (This surprise is due to ignorance )  they found no worthwhile benefit  either in the BP reduction or worsening renal function .

Now comes the evidence  in  2009  as   ASTRAL  trial from UK . ( As usual   the evidence came   late after ,  few lakhs  of kidneys   been injured !*

* Renal interventions are notorious for many complications , which is often not reported . Read this article to know  it better.

Final message

Common sense can  work great wonders than the much hyped RCTs . (Except ASTRAL  of course !) In this era of scarcity of  such  sense we can expect another study soon , to nullify ASTRAL  and give us further license  to pursuit the  good old  human instinct  ! Already silent noises  are made in interventional  corridors questioning the  outcome of ASTRAL.


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