The MORAL of CORAL

The CORAL trial finally has arrived. Stenting the renal vessels has always been a topic of debate.  This is the largest trial to date that directly compared intervention to medical therapy in atherosclerotic renal stenosis.

1. Investigators randomly assigned over 900 patients to either medical therapy or stenting.
2. Cardiovascular or renal events were the end points. - MI, stroke, need for ESRD and or death
3. 43 months of follow up and no different in primary endpoints. No difference in mortality. Blood pressure slight better in stent group
4. Meds that were used in their protocol:- Atacand with or without HCTZ and a combo of CCB and statin.
5. All renal arteries with stenosis >60% or more were treated( prior studies some severe cases were excluded)
6. Close to 50% in both arms had patients with CKD stage 3 or higher( makes it hard to offer stenting already)
7. Looking closely at the data, it appears that there were more strokes in the medical therapy arm but still not statistically significant. Interestingly, more patients reached ESRD in stent arm than medical therapy arm but not statistically significant.
8. Author's recommendation- no significant benefit to stenting in atherosclerotic renal artery disease.

Is this the end of RAS in atherosclerotic renal disease?-I think so!