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Renal Artery Stenosis: New Findings from the CORAL Trial

  • Peripheral Vascular Disease (CJ Cooper and R Gupta, Section Editors)
  • Published:
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Abstract

Purpose of Review

The goal of this review is to summarize recent advances in the field and highlight important new insights from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial regarding the optimal management of patients with renal artery stenosis (RAS).

Recent Findings

The CORAL trial demonstrated that subjects with RAS had similar outcomes whether randomized to optimal medical therapy alone or optimal medical therapy plus renal artery stenting. Subgroup analyses have failed to demonstrate that baseline blood pressure or lesion gradients can predict which subjects may have improved response after stent intervention. Importantly, urine albumin to creatinine ratio appears to different subjects that may benefit from stent intervention versus subjects that are unlikely to achieve any benefit. In addition, there was a trend toward increase benefit in subjects with greater percent stenosis.

Summary

Atherosclerotic RAS is a frequent finding and is often seen in patients with resistant hypertension, congestive heart failure, chronic kidney disease, and rarely those who need renal replacement therapy. Risk factors for RAS overlap with those of generalized atherosclerosis including hyperlipidemia, smoking, hypertension, and diabetes. Patients with CAD or PVD frequently have co-existing RAS. The management of RAS has been controversial for many years. The CORAL trial provides important insights into the optimal management of subjects with RAS.

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Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Authors and Affiliations

  1. University of Toledo Medical Center, 3000 Arlington Ave, MS# 1118, Toledo, OH, 43614, USA

    Rajesh Gupta, Salem Assiri & Christopher J. Cooper

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  1. Rajesh Gupta
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  2. Salem Assiri
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  3. Christopher J. Cooper
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Corresponding author

Correspondence to Rajesh Gupta.

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Conflict of Interest

Rajesh Gupta and Salem Assiri declare that they have no conflict of interest.

Christopher J. Cooper reports grants from NIH and Pfizer, grants and other from AstraZeneca, and grants and other from Cordis.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Peripheral Vascular Disease

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Gupta, R., Assiri, S. & Cooper, C.J. Renal Artery Stenosis: New Findings from the CORAL Trial. Curr Cardiol Rep 19, 75 (2017). https://doi.org/10.1007/s11886-017-0894-2

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  • DOI: https://doi.org/10.1007/s11886-017-0894-2

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