Practice changes in renal artery stenting after the CORAL trial

INTRODUCTION: Renal angioplasty emerged as an alternative for renal artery stenosis (RAS). In 2009 and 2014, two clinical trials (ASTRAL and CORAL) led to a paradigm shift in renovascular disease. Neither showed a clear benefit over best medical treatment, although there were methodological flaws. This study aims to evaluate the impact of these trials in clinical practice. METHODS: We designed a retrospective cross-sectional study from patients submitted to renal artery angioplasty between 1999 and 2021 in a tertiary center. Patients were selected from the center’s surgical records. Diagnostic arteriograms, open interventions and renal graft failures were excluded. Patients were divided in two cohorts: a historical group from 1999 to 2013 and a contemporary cohort, from 2014 to 2021. We compared the number of angioplasties per year and patient comorbidities, preoperative lesion severity, renal function, and the number of antihypertensive drugs. RESULTS: 152 patients were included: 104 patients between 1999-2013 (7 cases per year [5-8]) and 48 patients between 2014-2021 (6.5 cases per year [4.5-7]), with no significant difference between medians (p=0.53). Patients included between 2014-2021 were taking more antihypertensive drugs (3 [2-4] vs. 2 [1-3]; p=0.001) with a worse renal function (eGFR 44,2 ± 25,9 vs. 68,6 ± 29,2; p