Renal angioplasty and stenting for the treatment of atherosclerotic renal artery stenosis has become the initial procedure of choice in many institutions. This is due to the high acute technical success rates of 98% to 99%, with restenosis rates of 12% at 2 years with the use of balloon-expandable stents. Restenosis can usually be treated with a repeat percutaneous intervention, with secondary patency rates of up to 98% at 4 years. Average mortality rates of 1.7% with significant morbidity rates of 2.7% are significantly lower than those reported in most surgical series. In addition, with the advent of newer low-profile technology and increased experience at large institutions, these rates can be expected to decline even further. Cure of hypertension can be expected to occur in 10% to 20% of patients with improvement of blood pressure control in another 50% to 60% of patients. Similarly, improvement in renal insufficiency can be expected to occur in up to 30% of patients. Further advancements in technology such as the use of drug-eluting stents, protection devices, brachytherapy, and mechanical debulking devices may all serve to improve results. This paper reviews the development of our current endovascular technique for the management of renal artery stenosis along with results, complications, and areas for future development.
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