Renal artery stenosis (RAS) is a common cause of secondary hypertension (HTN) and may lead to resistant (refractory) HTN despite guideline directed medical therapy. Although randomized controlled trials comparing medical therapy to medical therapy and renal artery stenting have shown no benefit with renal artery stenting, according to comparative effectiveness reviews by the Agency for Healthcare Research and Quality, the trials did not enroll patients with the most severe RAS who would be more likely to benefit from renal stenting. Because of limitations of conventional angiography, it is important to assess the hemodynamic severity of moderate (50%-70%) RAS lesions with a hemodynamic measurement. We review techniques to optimize patient selection, to minimize procedural complications, and to facilitate durable patency of renal stenting. We also review the current ACC/AHA Guidelines and SCAI Appropriate Use Criteria as they relate to renal stenting.

中文翻译：

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抵抗性高血压的肾脏血运重建。

肾动脉狭窄（RAS）是继发性高血压（HTN）的常见原因，尽管有指导性的药物治疗方法，但仍可能导致耐药性（难治性）HTN。尽管将药物治疗与药物治疗和肾动脉支架置入术进行比较的随机对照试验显示，肾动脉支架置入术无益处，但根据美国医疗保健研究与质量局的比较有效性评估，该试验并未招募患有最严重RAS的患者更可能受益于肾脏支架置入术。由于常规血管造影术的局限性，重要的是通过血液动力学测量来评估中度（50％-70％）RAS病变的血液动力学严重程度。我们审查了可优化患者选择，最大程度减少手术并发症并促进肾脏支架置入术持久通畅的技术。