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Renal artery stenting for patients with atherosclerotic stenoses and hypertension seemed like an obvious and elegant solution to restore blood flow and lower blood pressure. Yet, as we reported in a 2009 Top Story, two randomized trials, ASTRAL and STAR, failed to show a significant benefit of stenting among patients with hypertension and stenoses of ≈50% or higher (NEJM JW Gen Med Dec 31 2009). The primary criticism of these earlier studies was that they included patients who did not have clinically significant renal artery stenosis. In 2013, CORAL addressed this primary criticism.
In CORAL, 947 patients with resistant hypertension or stage ≥3 chronic kidney disease and atherosclerotic renal artery stenosis (mean stenosis, 73%) were randomi…