IR Playbook pp 293-304 | Cite as

Renal Artery Stenosis

  • Andre Uflacker
  • Alan H. MatsumotoEmail author


Renal artery stenosis (RAS) is the anatomic narrowing of one or more of the arteries to the kidney(s), most commonly caused by atherosclerosis. This chapter will review the causes of renal artery stenosis (RAS), and the pathophysiological changes and clinical manifestations that may occur due to RAS. Additionally, it will discuss the noninvasive imaging tests that are used to demonstrate the presence of RAS, how to determine its hemodynamic significance, and the role percutaneous transluminal angioplasty and renal artery stent placement play in the treatment of RAS.


Renal artery stenosis Fibromuscular dysplasia Stents Angioplasty Renovascular hypertension 


  1. 1.
    Goldblatt H, Lynch J, Hanzai RF, Summerville WW. Studies on experimental hypertension; production of persistent elevation of systolic blood pressure by means of renal ischemia. J Exp Med. 1934;59:347–79.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Textor SC, Lerman LO. Paradigm shifts in atherosclerotic renovascular disease: where are we now? J Am Soc Nephrol. 2015;26(9):2074–80.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Textor SC. Renal arterial disease and hypertension. Med Clin North Am. 2017;101:65–79.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Parikh SA, Shishehbor MH, Gray BH, White CJ, Jaff MR. SCAI expert consensus statement for renal artery stenting appropriate use. Catheter Cardiovasc Interv. 2014;84:1163–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Textor SC, McKusick MM. Renal artery stenosis: if and when to intervene. Curr Opin Nephrol Hypertens. 2016;25:144–51.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Messerli FH, Bangalore S. Renal denervation for resistant hypertension? N Engl J Med. 2014;370:1454–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Cooper CJ, Murphy TP, Cutlip DE, Jamerson K, Henrich W, Reid DM, et al. Stenting and medical therapy for atherosclerotic renal artery stenosis. The CORAL trial. N Engl J Med. 2014;370:13–22.CrossRefPubMedGoogle Scholar
  8. 8.
    Carr TM, Sabri SS, Turba UC, Park AW, Saad WEA, Angle JF, Matsumoto AH. Stenting for atherosclerotic renal artery stenosis. Tech Vasc Interv Radiol. 2010;12:134–45.CrossRefGoogle Scholar
  9. 9.
    Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, et al. The US registry for fibromuscular dysplasia: results in the first 447 patients. Circulation. 2012;125:3182–90.CrossRefPubMedGoogle Scholar
  10. 10.
    O’Connor SC, Gornik HL. Recent developments in the understanding and management of fibromuscular dysplasia. JAHA. 2014;3:e001259.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Meuse MA, Turba UC, Sabri SS, Park AW, Saad WEA, Angle JF, Matsumoto AH. Treatment of renal artery fibromuscular dysplasia. Tech Vasc Interv Radiol. 2010;13:126–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Murphy TP, Cooper CC, Pencina KM, D'Agostino R, Massaro J, Cutlip DE, et al. Relationship of albuminuria and renal artery stent outcomes: results from the CORAL randomized clinical trial (Cardiovascular Outcomes with Renal Artery Lesions). Hypertension. 2016;68:1145–52.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Misra S, Khosla A, Allred J, Harmsen WS, Textor SC, McKusick MA. Mortality and renal replacement therapy after renal artery stent placement for atherosclerotic renovascular disease. J Vasc Interv Radiol. 2016;27(8):1215–24.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lewis S, Kadian-Dodov D, Bansai A, Lookstein RA. Multimodality imaging of fibromuscular dysplasia. Abdom Radiol. 2016;41:2048–60.CrossRefGoogle Scholar
  15. 15.
    Mamoulakis C, Tsarouhas K, Fragkiadoulak I, Heretis I, Wilks MF, Spandidos DA, et al. Contrast-induced nephropathy: basic concepts, pathophysiological implications and prevention strategies. Pharmacol Ther. 2017; 180: 99-112.CrossRefGoogle Scholar
  16. 16.
    Idee J, Fretellier N, Robic C, Corot C. The role of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: a critical update. Crit Rev Toxicol. 2014;44:895–913.CrossRefPubMedGoogle Scholar
  17. 17.
    Noory E, Sritharan K, Zeller T. To stent or not to stent? Update on revascularization for atherosclerotic renovascular disease. Curr Hypertens Rep. 2016;18:45.CrossRefPubMedGoogle Scholar
  18. 18.
    De Bruyne B, Manoharan G, Pijls NHJ, Verhamme K, Madaric J, Bartunek J, et al. Assessment of renal artery stenosis severity by pressure gradient measurements. J Am Coll Cardiol. 2006;48:1851–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Leesar MA, Varma J, Shapira A, Fahsah I, Raza ST, Elghoul Z, et al. Prediction of hypertension improvement after stenting of renal artery stenosis: comparative accuracy of translesional pressure gradients, intravascular ultrasound, and angiography. J Am Coll Cardiol. 2009;53:2363–71.CrossRefPubMedGoogle Scholar
  20. 20.
    Dangas G, Laird JR Jr, Mehran R, Lansky AJ, Mintz GS, Leon MB. Intravascular ultrasound-guided renal artery stenting. J Endovasc Ther. 2001;8:238–47.CrossRefPubMedGoogle Scholar
  21. 21.
    Raman G, Adam GP, Halladay CW, Langberg VN, Asodo IA, Balk EM. Comparative effectiveness of management strategies for renal artery stenosis. An updated systematic review. Ann Intern Med. 2016;165:635–49.CrossRefPubMedGoogle Scholar
  22. 22.
    Tegtmeyer CJ, Selby JB, Hartwell GD, Ayers C, Tegtmeyer V. Results and complication of angioplasty in fibromuscular disease. Circulation. 1991;83(suppl):I155–61.PubMedGoogle Scholar
  23. 23.
    Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin P. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis. Hypertension. 2010;56:525–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Yang YK, Zhang Y, Meng X, Yang KQ, Jiang XJ, Wu HY, et al. Clinical characteristics and treatment of renal artery fibromuscular dysplasia with percutaneous transluminal angioplasty: a long-term follow-up study. Clin Res Cardiol. 2016;105:930–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Virginia Health System, Department of Radiology and Medical ImagingCharlottesvilleUSA

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