Table 2.

Issues central to determining role for renal revascularization in atherosclerotic RASa

QuestionsTools for Evaluation
Severity of vascular occlusion?Quantitative angiography, translesional gradients, intravascular ultrasound
Treatable?Vessel location, associated disease, accessory vessels, aneurysm, occlusion
Responsible for disease?Evident activation of pressor systems (e.g., renin) Duration of change (e.g., BP) renal function; other measures of tissue ischemia (e.g., BOLD MR, PET energy consumption); activation of fibrogenic, inflammatory, or oxidative pathways
Benefit from revascularization?Rapidity of evolution, preexisting injury (e.g., hypertension, diabetes, other kidney disease), comorbid disease risk, associated procedural risk to kidney (e.g., atheroembolic potential), response to other medical therapy Risk for disease progression, salvageability of kidney function (resistive index, BOLD MR)
  • a BOLD MR, blood oxygen level dependent magnetic resonance; PET, positron emission tomography.