Abstract
Background: Atherosclerotic renal artery stenosis is an important cause of resistant hypertension and renal dysfunction. Although major randomized trials such as ASTRAL and CORAL failed to demonstrate a clear benefit of routine revascularization, selected high-risk patients may still benefit from renal artery stenting. Case presentation: A 65-year-old man with resistant hypertension was diagnosed with hemodynamically significant bilateral renal artery stenosis on Doppler ultrasound. The patient underwent left renal artery stenting and was followed for blood pressure control and renal function before and after the procedure. Results: Blood pressure improved from 200/100 mmHg to 120/70-130/80 mmHg. Serum creatinine decreased from 121-142 µmol/L to 96-99 µmol/L, while estimated glomerular filtration rate (eGFR) improved from 47-57 to 73-76 mL/min/1.73 m². The number of antihypertensive medications decreased from four to two or three agents. No procedural complications were observed. Conclusion: In patients with resistant hypertension and hemodynamically significant bilateral renal artery stenosis, unilateral renal artery stenting combined with optimized medical therapy may improve blood pressure control and stabilize renal function. This case highlights the importance of careful patient selection based on clinical presentation and hemodynamic assessment.
