Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliation: Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada (firstname.lastname@example.org).
To the Editor: In their recent Viewpoint, Dr de Leeuw and colleagues1 suggested that clinical trials of stenting for renal artery stenosis should be done earlier in the disease process, before the participants have severe renal impairment. There are serious problems with the available literature.
In the study by Wheatley et al,2 60% of the participants had a serum creatinine level of 150 mmol/L or higher at the time of randomization, so the intervention was too late to achieve a benefit with regard to renal function. However, there are other equally or more important limitations of the literature in this area. In the study by Wheatley et al,2 only 79% of the participants randomized to the intervention actually had revascularization performed, and 6% of those randomized to medical therapy crossed over to the intervention.
Spence JD. Treatment of Renal Artery Stenosis. JAMA. 2013;309(22):2321-2322. doi:10.1001/jama.2013.5680