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UH Case Medical Center’s Dr. Parikh authors SCAI paper on expert
consensus recommendations for treatment of renal artery stenosis
Fourth Paper in Series Reviews Treatments for Patients Often Excluded from Clinical Trials
CLEVELAND – Renal artery stenting to open blockages in the kidney arteries may benefit
patients who have historically been excluded from modern clinical trials, according to new
recommendations for renal artery stenosis e-published in Catheterization and Cardiovascular
Interventions today by the Society for Cardiovascular Angiography and Interventions (SCAI).
University Hospitals Case Medical Center’s Sahil Parikh, MD, Director, Interventional
Cardiology Fellowship Program and Professor of Medicine, Case Western Reserve University
School of Medicine was the lead author on the paper that details possible assessment and
treatment guidelines for renal artery disease.
Blockages in the kidney (renal) arteries are often asymptomatic, but may lead to high blood
pressure or worsening of high blood pressure control. If left untreated, the disease can cause
kidney failure and heart failure. Optimal medical therapy remains the preferred first-line
treatment.
For patients whose condition is not controlled by medication, treating blocked arteries with
angioplasty and stenting may help reduce blood pressure and prevent progression of the
disease. Recent randomized controlled trials, including the Cardiovascular Outcomes in Renal
Atherosclerotic Lesions (CORAL) trial, have failed to demonstrate benefit of renal stenting
over optimal medical therapy. However, there were patients whose condition might be
improved by renal artery stenting who were excluded from the trial.
“The CORAL trial answered many of our questions about renal artery stenting, but some
patients who are seeking treatment today were not included in CORAL, including patients in
whom optimal medical therapy failed,” said Dr. Parikh. “The new recommendations were
developed to help physicians evaluate treatment options for the broad range of patients with
renal artery disease.”
Based on an expert panel review of scientific data, the document recommends that patients
most likely to benefit from renal artery stenting are those with cardiac disturbance syndrome
or “flash” pulmonary edema (the rapid onset of fluid buildup in the lungs); patients whose
high blood pressure has not been controlled by three or more medications at maximal
tolerated doses; and those with blockages in both kidneys or severe blockages in a single
functioning kidney where blood pressure or renal dysfunction cannot be managed medically.
In contrast, the expert panel recommends that patients with mild or moderate blockages (less
than 70 percent), those with long-standing loss of blood flow and those with complete
blockage of the renal artery are typically not good candidates for renal artery stenting. It is
unknown whether renal artery stenting can improve symptoms in patients with heart failure
over the long term. In addition, the expert consensus statement reviews the evidence and
expert opinion on the performance of renal artery angiography and intervention with stents.
The panel delineates the best practices for assessing arterial narrowing that is intermediate
(i.e. 50%-70%), which often does not limit blood flow.
“Most practicing physicians performing these procedures will find this guidance particularly
helpful in assessing renal artery disease in the future,” said Dr. Parikh.
The paper is the fourth in a series of recommendations developed by SCAI on treatment for
peripheral artery disease (PAD). The incidence of PAD is growing, and the series aims to help
interventional cardiologists determine the best course of treatment for patients whose blocked
arteries place them at risk of reduced blood flow that can lead to loss of a limb or organ
damage.
“As our understanding of PAD and its treatment options grows, physicians have the ability to
improve symptoms and quality of life for many more patients today,” said SCAI 2014-15
President Charles Chambers, M.D., FSCAI. “Our series of treatment recommendations is
designed to help interventional cardiologists provide the best possible care based on each
patient’s individual symptoms and condition.”
About SCAI
The Society for Cardiovascular Angiography and Interventions is a 4,000-member professional organization
representing invasive and interventional cardiologists in approximately 70 nations. SCAI's mission is to promote
excellence in invasive/interventional cardiovascular medicine through physician education and representation,
and advancement of quality standards to enhance patient care. SCAI's public education program, Seconds Count,
offers comprehensive information about cardiovascular disease. For more information about SCAI and Seconds
Count, visit http://www.SCAI.org/ or www.SecondsCount.org<http://www.scai.org/secondscount/Default.aspx>.
Follow @SCAI<http://www.Twitter.com/SCAI> and @SCAINews<http://www.Twitter.com/SCAINews> on
Twitter for the latest heart health news.
About University Hospitals
University Hospitals, the second largest employer in Northeast Ohio with 25,000 employees, serves the needs of
patients through an integrated network of 12 hospitals, 26 outpatient centers and primary care physician offices
in 15 counties. At the core of our $3.5 billion health system is University Hospitals Case Medical Center, ranked
among America’s 50 best hospitals by U.S. News & World Report in all 12 methodology-ranked specialties. The
primary affiliate of Case Western Reserve University School of Medicine, UH Case Medical Center is home to
some of the most prestigious clinical and research centers of excellence in the nation, including cancer,
pediatrics, women's health, orthopaedics, radiology, neuroscience, cardiology and cardiovascular surgery,
digestive health, transplantation and genetics. Its main campus includes UH Rainbow Babies & Children's
Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's
only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive
Cancer Center at Case Western Reserve University. For more information, go to www.uhhospitals.org.