6/28/23, 12:46 AM ASTRAL Pathway Feedback Search Clinical Topics Home Studies ASTRAL ASTRAL Disease Disease Hypertension Renal artery stenosis Trial question What is the role of percutaneous revascularization in patients with atherosclerotic renovascular disease? Study design Multi-center Open label RCT Population Characteristics of study participants 37.0% female N = 806 63.0% male 806 patients (299 female, 507 male) Inclusion criteria: patients with atherosclerotic renovascular disease Key exclusion criteria: requirement of surgical revascularization or high likelihood of requiring revascularization within 6 months, nonatheromatous CVD, or undergone previous revascularization for renal artery stenosis Interventions N=403 revascularization (with angioplasty either alone or with stenting plus medical therapy with statins, antiplatelet agents, and optimal blood-pressure control) N=403 medical therapy (statins, antiplatelet agents, and optimal blood-pressure control) https://web.pathway.md/studies/rec4BhsOgM7sgQC2B 1/2 6/28/23, 12:46 AM ASTRAL Pathway Primary outcome No significant difference in the incidence of decline in serum creatinine (-0.07 10 L/ mol/year vs. -0.13 10 L/ mol/year; MD 0.06, 95% CI 0 to 0.13) Secondary outcomes No significant difference in renal events (22% vs. 22%; HR 0.97, 95% CI 0.67 to 1.4) No significant difference in major cardiovascular events (49% vs. 51%; HR 0.94, 95% CI 0.75 to 1.19) No significant difference in death (60% vs. 57%; HR 0.9, 95% CI 0.69 to 1.18) Conclusion In patients with atherosclerotic renovascular disease, revascularization was superior to medical therapy with respect to the incidence of decline in serum creatinine. Reference ASTRAL Investigators, Wheatley K, Ives N et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med. 2009 Nov 12;361(20):1953-62. Open reference URL https://web.pathway.md/studies/rec4BhsOgM7sgQC2B 2/2