Background: Renal artery stenosis (RAS), primarily caused by atherosclerosis, leads to resistant hypertension, progressive renal dysfunction, and cardiovascular complications. Treatment options include medical therapy and revascularization, with the latter offering significant benefits in selected cases. This report details a successful staged revascularization approach, demonstrating notable clinical improvements in a patient with bilateral RAS.

Case presentation: A 65-year-old woman with persistent hypertension (SBP >180 mmHg) despite triple antihypertensive therapy presented with occipital headaches, dizziness, and exertional dyspnea. Renal Doppler ultrasonography and angiography confirmed critical bilateral RAS, with 95% stenosis in the right renal artery and 90% in the left. Laboratory tests revealed impaired renal function with a serum creatinine of 1.7 mg/dL and an estimated glomerular filtration rate (eGFR) of 34 mL/min/1.73 m². Given the severity of her condition, a staged revascularization strategy was implemented, with the right renal artery treated first, followed by the left artery three months later. Both procedures were performed successfully without complications. Post-intervention, the patient experienced a substantial reduction in blood pressure and symptomatic relief, with follow-up at three months showing improved renal function, reflected in decreased serum creatinine levels and increased eGFR.

Conclusion: This case demonstrates the significant benefits of staged revascularization in managing complex RAS, resulting in substantial improvements in blood pressure control, renal function, and symptom relief. It underscores the importance of a tailored approach in achieving optimal clinical outcomes in high-risk RAS patients.

Renal artery stenosis, Revascularization, Angioplasty, Stents, Hypertension, Renovascular, Renal function