Clinical & Experimental Cardiology
Open Access

Benefits of Atherectomy in Renal Artery Disease: Preventing Renal Failure

Alexis Marie^{* *}Correspondence: Alexis Marie, Department of Cardiology, University of Oxford, Oxford, United Kingdom, Email:

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Description

Renal artery disease, often caused by Renal Artery Stenosis (RAS), is a narrowing or blockage of the arteries that supply blood to the kidneys. This condition can lead to hypertension (high blood pressure), Chronic Kidney Disease (CKD) and ultimately, renal failure if left untreated. Among the available therapeutic options, atherectomy-a minimally invasive procedure that removes plaque from arteries-has emerged as a promising intervention for managing renal artery disease and preventing its most severe consequences, including renal failure.

Renal artery stenosis is primarily caused by atherosclerosis, a condition characterized by the buildup of fatty deposits (plaque) within the walls of arteries. As the plaque accumulates, the arterial lumen narrows, restricting blood flow to the kidneys. Reduced blood flow limits the kidneys’ ability to regulate blood pressure and filter waste from the blood, which can progressively damage kidney function. Over time, if untreated, this can lead to chronic kidney disease or, in the most severe cases, renal failure. Two major consequences of renal artery disease are secondary hypertension and ischemic nephropathy. Secondary hypertension occurs because the kidneys, sensing reduced blood flow, release hormones that elevate blood pressure in an attempt to increase perfusion. Unfortunately, this can exacerbate cardiovascular problems. Ischemic nephropathy refers to kidney damage caused by prolonged lack of adequate blood flow, which, without intervention, leads to irreversible damage and renal failure. Atherectomy is a minimally invasive endovascular procedure designed to remove plaque from the arterial walls, restoring proper blood flow through the affected arteries. It differs from balloon angioplasty, which simply pushes the plaque against the arterial walls and stenting, which involves the placement of a metal scaffold to keep the artery open. Atherectomy physically removes the plaque from the artery, reducing the likelihood of restenosis (re-narrowing of the artery) and providing more definitive relief of obstruction.

Atherectomy plays an important role in the treatment of renal artery disease because it directly addresses the root cause of the problem: The atherosclerotic plaque buildup in the renal arteries. By physically removing the obstruction, atherectomy restores normal blood flow to the kidneys, allowing them to function properly. This helps to control blood pressure, reduce the risk of further kidney damage and prevent the progression to renal failure. The primary benefit of atherectomy in renal artery disease is the restoration of blood flow to the kidneys. As plaque is removed, the lumen of the artery is widened, reducing the resistance to blood flow. This increased perfusion improves the kidneys’ ability to filter blood and regulate blood pressure. In cases of severe renal artery stenosis, the kidneys receive insufficient oxygen and nutrients, leading to ischemic injury and subsequent kidney dysfunction. Atherectomy mitigates this by directly removing the obstruction, allowing oxygenated blood to reach the renal tissue. This can significantly improve kidney function, especially in patients with ischemic nephropathy, preventing further deterioration and potentially reversing earlystage damage. Hypertension is a common consequence of renal artery stenosis, as reduced blood flow to the kidneys triggers the release of renin, a hormone that increases blood pressure. Traditional treatments for high blood pressure, such as medications, may not be sufficient in cases of RAS, as the underlying cause is the obstructed artery itself.

By removing the plaque and improving blood flow, atherectomy helps to reduce the kidneys’ overproduction of renin, leading to better control of blood pressure. This is particularly beneficial for patients with resistant hypertension, where blood pressure remains elevated despite the use of multiple antihypertensive medications. Improved blood pressure control not only reduces the risk of kidney failure but also lowers the risk of cardiovascular events such as heart attack and stroke. The most severe consequence of untreated renal artery stenosis is renal failure, a condition in which the kidneys lose the ability to filter waste products from the blood, ultimately requiring dialysis or a kidney transplant. By intervening early with atherectomy, it is possible to halt the progression of renal artery disease before it reaches this critical stage. Atherectomy provides a definitive treatment by removing the plaque and reducing the chances of restenosis.

Conclusion

Atherectomy represents a valuable and effective treatment option for patients with renal artery disease. By directly removing atherosclerotic plaque, the procedure restores normal blood flow to the kidneys, improves blood pressure control and prevents the progression of kidney damage. For patients at risk of renal failure due to renal artery stenosis, atherectomy can be a life-saving intervention that preserves kidney function and improves overall cardiovascular health. As technology continues to advance, atherectomy is likely to become an increasingly important tool in the management of renal artery disease, offering hope to patients who might otherwise face the prospect of renal failure.