Prognosis

General outlook

Higher mortality and dialysis rates occur if there is worsening baseline kidney function, higher-grade stenosis, extensive coronary artery disease or peripheral vascular disease, or older age.[54]

Hypertension control

In bilateral RAS, angioplasty with stent deployment may be more effective than medical treatment alone regarding the goal of better BP control. [ Cochrane Clinical Answers logo ] Patients may require fewer medications for control of hypertension after stenting. An exceedingly small percentage of patients may be cured of hypertension.[54]

Kidney function

Current evidence indicates that kidney outcomes are no different with medical therapy or interventional therapy. However, kidney function improvement has only been reported in patients undergoing angioplasty.[54]

Medical therapy vs. interventional procedures: complications

Evidence does not support meaningful conclusions about relative adverse events or complications of percutaneous vascular intervention compared with medical treatment.[55] However, interventional therapy is associated with complications related to the procedure.

Patients undergoing renal artery percutaneous vascular intervention (angioplasty with or without stent deployment) require dual antiplatelet therapy (aspirin and clopidogrel) after the procedure. This carries a risk of bleeding.

Cardiovascular outcomes

There is no difference in cardiovascular outcomes between medical therapy and interventional procedures.[46][55][56]

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