Henrich, co-authors find renal-artery stents don’t reduce major events

SAN ANTONIO (Nov. 19, 2013) — William L. Henrich, M.D., MACP, a renal specialist who is president of The University of Texas Health Science Center at San Antonio, co-authored a multicenter research study published this week in The New England Journal of Medicine. The CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) trial compared cardiovascular and renal outcomes of elderly patients presenting with renal-artery stenosis and hypertension or chronic kidney disease. One group was treated with renal-artery stenting and medicine while a second group was treated with medicine alone.

Although a modest decrease in systolic blood pressure was noted in the stent-treated patients, the CORAL investigators found no difference between the groups in the occurrence of cardiovascular and renal events such as heart attack, stroke, hospitalization for congestive heart failure and progressive renal insufficiency. Patient follow-up averaged 3½ years.

“The renal arteries, which carry blood to the kidneys, become occluded in an estimated 1 percent to 5 percent of elderly patients with arterial disease,” Dr. Henrich said. “This contributes to hypertension, ischemic nephropathy resulting in kidney cell death, and other long-term complications. Stents may be placed to restore circulation in these arteries. Our study evaluated whether stents, when added to medical therapy, decreased the occurrence of adverse events. Our findings showed this is not the case.”

The CORAL study enrolled more than 900 participants from medical centers including the UT Health Science Center, where Dr. Henrich is a nephrologist with UT Medicine San Antonio, the clinical practice of the School of Medicine. Lead author of the paper is Christopher J. Cooper, M.D., of the University of Toledo.

According to the CORAL investigators, renal-artery stenting for Medicare beneficiaries grew rapidly in the 1990s, with annual procedure volumes increasing 364 percent between 1996 and 2000. However, three randomized trials of renal-artery angioplasty failed to demonstrate a blood pressure benefit. No previous trial had as its primary endpoint adverse clinical events.


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