The STAR Study. Cardiovascular Disease Antihypertensives The STAR Study Stent Placement in Patients with Atherosclerotic Renal Artery Stenosis and Impaired.

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The STAR Study

Cardiovascular Disease Antihypertensives The STAR Study Stent Placement in Patients with Atherosclerotic Renal Artery Stenosis and Impaired Renal Function Reference Bax L, Woittiez AJ, Kouwenberg HJ, et al. Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial. Ann Intern Med. 2009;150(12):840–848, W150–151.

Background Atherosclerotic renal artery stenosis (ARAS) is a reasonable treatment strategy for the patients with bilateral disease or a solitary functioning kidney, whereas it may be considered an option for patients with unilateral stenosis. However, little is known about the safety and efficacy of renal artery stenting in patients with ARAS.

Aim To determine the efficacy and safety of stent placement in patients with ARAS and impaired renal function.

Methods

Summary of Key Results Ten patients (16%) in the stent placement group and 16 patients (22%) in the medication group reached the primary endpoint. Event-free survival did not statistically significantly differ between the groups (log-rank P=0.44). Type of stenosis (unilateral or bilateral) was not a statistically significant effect modifier (P=0.41).

Safety 3% procedure-related deaths, 1 late death secondary to an infected hematoma, and 1 patient who required dialysis secondary to cholesterol embolism occurred in the stent group.

Conclusion This is the first trial that compares stent placement plus medication with medication only in patients with impaired renal function and ARAS. No statistically significant difference in progression of renal failure over 2 years in the two groups was observed. Several stent-related complications occurred; including two procedure-related deaths were reported. Stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications. Findings of this study favor a conservative therapeutic approach to patients with ARAS, focused on cardiovascular risk factor management without stenting.