Warfield AE, Morris CS, Bhave AD, Scriver GM, Massouh A, Kallen J, Solomon RT, Majdalany BS. Renal artery stenting for atherosclerotic renal artery stenosis: A review of contemporary data. World J Nephrol 2026; 15(3): 124524 [DOI: 10.5527/wjn.124524]
Corresponding Author of This Article
Bill S Majdalany, MD, FSIR, Professor, Department of Radiology, University of Vermont Medical Center, 111 Colchester Avenue Patrick 127, Burlington, VT 05401, United States. bill.majdalany@uvmhealth.org
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Sep 25, 2026; 15(3): 124524 Published online Sep 25, 2026. doi: 10.5527/wjn.124524
Renal artery stenting for atherosclerotic renal artery stenosis: A review of contemporary data
Bill S Majdalany, Richard T Solomon, Joshua Kallen, Alan Massouh, Geoffrey M Scriver, Anant D Bhave, Christopher S Morris, Andrew E Warfield
Andrew E Warfield, Christopher S Morris, Anant D Bhave, Geoffrey M Scriver, Alan Massouh, Joshua Kallen, Bill S Majdalany, Department of Radiology, University of Vermont Medical Center, Burlington, VT 05401, United States
Richard T Solomon, Department of Nephrology, University of Vermont Medical Center, Burlington, VT 05401, United States
Author contributions: Warfield AE, Morris CS, and Majdalany BS contributed to concept, data collection and analysis; Warfield AE and Majdalany BS contributed to first draft and revision; Bhave AD, Scriver GM, Massouh A, Kallen J, and Solomon RT contributed to manuscript editing. All authors have read and approved the final manuscript.
AI contribution statement: No AI tools were used in the preparation of this manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Bill S Majdalany, MD, FSIR, Professor, Department of Radiology, University of Vermont Medical Center, 111 Colchester Avenue Patrick 127, Burlington, VT 05401, United States. bill.majdalany@uvmhealth.org
Received: June 18, 2026 Revised: July 10, 2026 Accepted: July 28, 2026 Published online: September 25, 2026 Processing time: 57 Days and 6.2 Hours
Abstract
Renal artery stenting has been less frequently performed following the results of the Cardiovascular Outcomes in Renal Atherosclerotic Lesions trial. In this trial, stenting demonstrated no benefit over medical therapy in a composite outcome including mortality as well as cardiovascular and renal events. However, these findings must be interpreted in the context of the study population, which included many patients less likely to benefit from intervention due to relatively mild renal artery stenosis, as well as less severe hypertension and renal dysfunction. More recent investigations have focused on identifying subgroups of patients who may benefit from revascularization. Identified subgroups include patients with high systolic blood pressure, diastolic hypertension, worsening kidney function, greater antihypertensive burden, flash pulmonary edema, and mild-range proteinuria. Many of these variables illustrate a clinical picture of a patient with severe ischemic kidney disease leading to problems with hypertension and volume regulation that has not yet irreparably damaged the renal parenchyma. Deciding which patients fit into this picture, and therefore should be stented, presents a challenge. This review synthesizes the current evidence surrounding these predictive variables and explores how they may be integrated into clinical decision-making.
Core Tip: Patients likely to benefit from renal artery stenting are those with severe anatomic renovascular disease (stenosis > 80% and especially > 90% often bilaterally or in a single functioning kidney) and severe manifestations of that disease (high systolic and diastolic blood pressure despite at least 3 medications, rapidly declining kidney function with low levels of proteinuria, or flash pulmonary edema without other pathophysiologic explanations. These patients were not included in prior randomized controlled trials and represent a high-risk subset of patients with atherosclerotic renovascular stenosis. Survival benefits may be achieved especially in patients stented for rapidly declining kidney function.
