Table 1 Current indications for revascularization in clinical guidelines

From: How should we define appropriate patients for percutaneous transluminal renal angioplasty treatment?

 

SCAI appropriate use criteria [10]

ESC recommendations [11]

ACC/AHA recommendations [12]

JSH 2019 [13]

Year

2017

2017

2017

2019

Scenario

• Cardiac disturbance syndromesa with hypertension and moderate or severe RAS with resting translesional mean gradient ≥10 mmHg

• CKD stage IV with bilateral moderate RAS with resting mean translesional gradient ≥10 mmHg with kidney size >7 cm

• CKD stage IV and global renal ischemia without other explanation

• Resistant hypertensionb and bilateral or solitary severe RAS

Appropriate

• In cases of hypertension and/or signs of renal impairment related to renal arterial fibromuscular dysplasia

• Surgical revascularization should be considered for patients with complex anatomy of renal arteries, after failed endovascular procedure or during open aortic surgery

Class IIa/level of evidence B

• Failed medical management (refractory hypertension, worsening renal function, and/or intractable heart failure)

• Nonatherosclerotic disease, including fibromuscular dysplasia

Class IIb/level of evidence

Consensus of expert opinion based on clinical experience

• Fibromuscular dysplasia

• Resistant hypertension

• Worse/malignant hypertension

• Unexplained or repeated pulmonary edema/heart failure

• Bilateral renal artery stenosis or renal artery stenosis in solitary kidney

PTRA could be considered in patients with hemodynamically significant RAS

 

• Resistant hypertensionb and unilateral severe RAS

• CKD stage IV and unilateral moderate RAS with resting translesional mean gradient ≥10 mmHg without other explanation

• Recurrent CHF with unilateral moderate RAS with resting translesional mean gradient ≥10 mmHg

• CKD stage II with bilateral RAS

• CKD stage III, stable for 1 year, with bilateral severe RAS

• Resistant hypertensionb with severe unilateral RAS and anatomically challenging or high-risk lesionc

May be appropriate

• Unexplained recurrent congestive heart failure or sudden pulmonary edema

Class IIb/level of evidence C

    
  1. ACC/AHA American College of Cardiology/American Heart Association, CKD chronic kidney disease, ESC European Society of Cardiology, JSH Japanese Society of Hypertension, PTRA percutaneous transluminal renal angioplasty, RAS renal artery stenosis, SCAI Society for Cardiovascular Angiography and Interventions
  2. aFlash pulmonary edema or acute coronary syndrome
  3. bUncontrolled hypertension with failure of maximum tolerated doses of at least three antihypertensive agents, one of which is a diuretic, or intolerance to medications
  4. cEarly bifurcation, small vessel, severe concentric calcification, and severe aortic atheroma or mural thrombus
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