| Summary: | Considerable controversy remains regarding optimal strategies for evaluation and management of patients with ARAS. The evidence supporting benefit of aggressive diagnosis and treatment remains unclear. Meanwhile, a Medicare claims analysis found that the rate of percutaneous renal artery revascularization rapidly increased from 7,660 interventions in 1996 to 18,520 in 2000. To determine which patients with ARAS, if any, would most benefit from angioplasty with stent placement, as opposed to continued aggressive medical treatment, the National Institutes of Health has sponsored the large, multicenter Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial. This trial is currently enrolling subjects and plans to report results in 2010. Meanwhile, the Agency for Healthcare Research and Quality (AHRQ) has commissioned a review of the evidence on the effectiveness of renal artery angioplasty with stent placement vs. aggressive medical therapy. This review was commissioned under Section 1013 of the Medicare Modernization Act, which calls for comparative effectiveness reviews on medications and devices. AHRQ requested that the Tufts-New England Medical Center Evidence-based Practice Center (Tufts-NEMC EPC) conduct a review of the literature on the comparative effectiveness of management strategies for renal artery stenosis. This report summarizes the evidence evaluating the effect and safety of angioplasty with stent placements and medical therapies in the treatment of ARAS, particularly after long-term followup
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