Long Term Outcomes After Renal Revascularization for Atherosclerotic Renovascular Disease in the ASTRAL Trial.

6 Although the RCTs have concluded the absence of benefit from stenting, the trials had limitations, notably that the enrolled populations only included a minority of patients with high-risk clinical presentations (very severe hypertension, rapidly declining renal function, heart failure, and highly significant RAS), questioning the generalizability of the results to clinical practice. 5 , 6 Additionally, both ASTRAL and CORAL did not enroll some patients who may have benefited from intervention at the preference of their treating physicians. 5 , 6 In practice, many high-risk patients (those with severe hypertension, heart failure, or rapidly deteriorating kidney function) with high-grade RAS continue to undergo revascularization.

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The follow-up data showed no overall benefit of renal revascularization to renal and CV outcomes, although a trend towards significance was observed in both the composite CORAL end point and mortality in the severe RAS subgroup, albeit this was a post hoc analysis.

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