FRACTIONAL FLOW RESERVE (FFR)-guided renal artery stenting reduces unnecessary interventions and selectively benefits patients with atherosclerotic renal artery stenosis (ARAS) and hypertension, according to the FAIR randomized trial. Compared with traditional angiography-guided revascularization, FFR guidance halved the stenting rate but matched blood pressure and medication improvements.
FFR Guidance for Renal Artery Stenosis
Renal artery stenosis is a leading cause of renovascular hypertension, but risks and unclear benefits have made stenting controversial. The FAIR trial randomly assigned 101 ARAS patients to receive either angiography-led stenting or FFR-guided intervention, where stents were only placed for patients with FFR < 0.80, reflecting significant functional stenosis. Stenting based on FFR resulted in a lower intervention rate (46% vs 100%, P < .01), sparing nearly half of patients from unnecessary procedures.
Results: Blood Pressure and Medication Outcomes
Blood pressure and antihypertensive medication use decreased similarly in both groups, but only patients with FFR < 0.80 benefitted meaningfully from stenting, with an adjusted mean systolic blood pressure drop of 6.2 mmHg and a medication reduction of 3.1 units. Patients with FFR ≥ 0.80 did not experience significant improvements – highlighting FFR’s value in identifying candidates likely to benefit.
Implications for ARAS Treatment
FFR-guided revascularization offers a safe and practical approach, delivering clinical gains while minimising unnecessary stenting. These findings suggest future ARAS management should focus on functional severity rather than anatomy alone, and call for further research into clinical outcomes and long-term benefits of FFR-directed interventions.
Reference
Li Y et al. Fractional flow reserve-guided renal artery stenting in atherosclerotic renovascular hypertension: the FAIR randomized trial. European Heart Journal. 2025:ehaf746.
