ASTRAL

• Baseline creatinine, 2.02 mg/dl; glomerular filtration rate, 40 ml/min; mean stenosis, 76%; antihypertensive medications, 2.8 per patient

• 93% of revascularized patients received a stent

• At follow-up, no difference in creatinine, blood pressure, time to first renal event, or mortality (p = NS for all outcomes)

Trial design: Patients with significant renal artery stenosis were randomized to angioplasty and/or stenting plus medical therapy (n = 403) or medical therapy alone (n = 403) and followed for 27 months.

Results

Conclusions

• Renal artery revascularization is not superior to medical therapy alone

• Renal artery stenting does not reduce creatinine, blood pressure, time to first renal event, adverse cardiac events, or mortality

(p = 0.46) (p = 0.96)

The ASTRAL Investigators. NEJM 2009;361:1953-62

Renal stenting (n = 403)

Medical therapy(n = 403)

%

All-cause mortality CV event

25.6 26.335.0 36.0