Renal Rescue Stories: Lessons from Renal Stenting Cases and the Role of Intravascular Ultrasound

Renal artery stenosis (RAS) is a significant cause of renovascular hypertension and ischemic nephropathy. While medical therapy remains the cornerstone of management, revascularization using renal artery stenting is invaluable in select patients with symptomatic, hemodynamically significant stenosis. Here, we present two contrasting cases of renal artery stenting: The first, a straightforward case of right RAS in a postcoronary artery bypass graft patient with refractory hypertension with some challenges for procedural planning, and the second, a complex scenario involving calcified left RAS. The second case highlights the utility of intravascular ultrasound (IVUS) in lesion assessment and advanced tools like scoring balloons in lesion preparation. This case series emphasizes the importance of tailored interventional strategies for optimal outcomes and reviews relevant literature on IVUS-guided renal revascularization.