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Renal Artery Stenosis — EECC MCQ

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HardHypertension & Preventive CardiologyRenal Artery StenosisEECC

A 55-year-old man with unilateral renal artery stenosis (80% stenosis on CT angiography), refractory hypertension on four agents, and declining renal function (eGFR 38 mL/min/1.73 m², down from 55 over 12 months) is assessed. What is the most appropriate management?

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Correct answer: E — Renal artery revascularisation (angioplasty with or without stenting) should be considered given progressive renal impairment

While the ASTRAL and CORAL trials showed no benefit of routine renal artery stenting over medical therapy alone for atherosclerotic renal artery stenosis, these trials excluded patients with rapidly declining renal function. The ESC Hypertension Guidelines and ACC/AHA guidance recognise that renal artery revascularisation should be considered in patients with: (1) progressive decline in renal function attributable to the stenosis, (2) refractory/resistant hypertension despite optimal multi-drug therapy, (3) recurrent flash pulmonary oedema, or (4) unstable angina. This patient has both progressive renal decline and refractory hypertension, making him a reasonable candidate for revascularisation.

Reference: ESC (2024): Guidelines for the Management of Elevated Blood Pressure and Hypertension