CORAL Study Finds No Benefit of Stenting in Renal Artery Stenosis

A worldwide, multicenter trial shows no reduction in clinical events with renal artery stenting for patients with atherosclerotic renal artery stenosis, reports the New England Journal of Medicine.

The “Cardiovascular Outcomes in Renal Atherosclerotic Lesions” (CORAL) study included 947 patients with atherosclerotic renal artery stenosis. Eligible patients were taking two or more antihypertensive drugs, had chronic kidney disease, or both. The open-label study randomly assigned patients to medical therapy alone or medical therapy plus renal artery stenting. The main outcome of interest was a composite of death resulting from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or renal replacement therapy.

At a median follow-up time of 43 months, the primary outcome rates were almost identical between groups: 35.1 percent with renal artery stenting and 35.8 percent with medical therapy alone. The individual component outcomes and all-cause mortality were similar as well.

Stenting also showed no benefit in patients with global renal ischemia or in other high-risk subgroups. The lack of clinical benefit was observed despite a reduction in systolic blood pressure in the stenting group: 2.3 mm Hg lower than with medical therapy alone.

There is a long history of uncertainty over the role of stenting in treatment of renal artery stenosis related to atherosclerosis. The CORAL results show no improvement in outcomes with renal artery stenting, compared with medical therapy alone, for patients with renal artery stenosis and hypertension or chronic kidney disease. “From this result, it is clear that medical therapy without stenting is the preferred management strategy for the majority of people with atherosclerotic renal-artery stenosis,” the researchers conclude [Cooper CJ, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med 2013; 370:13–22].