ABSTRACT
PTRA or PTRS is supported in patients with a hemodynamically significant RAS and an appropriate clinical condition for treatment (Table 50.1) (11,12). Intervention for accelerated, resistant, or malignant hypertension as well as hypertension with an unexplained unilateral small kidney or with intolerance to medication is considered by the ACC/AHA guidelines to be a Class IIa (Level of Evidence: B) treatment. Similarly, PTRS for RAS and progressive chronic kidney disease with bilateral RAS or RAS to a solitary functioning kidney is a Class IIa (Level of Evidence: B) treatment. Revascularization for patients with chronic renal insufficiency with unilateral RAS is a Class IIb (Level of Evidence: C) therapy. In contrast, stenting for significant RAS and recurrent, unexplained CHF or sudden, unexplained pulmonary edema is a Class I (Level of Evidence: C) intervention (12). Obviously, such guidelines will undergo periodic reevaluation as increasing data are accumulated regarding the role and relative outcomes of PTRS and other potential treatments (7,14).
