Renal artery stenosis is the most common cause of secondary hypertension, accounting for about 1% of all hypertension, and severe renal artery stenosis can lead to progressive renal damage and even loss of renal function. For many years, renal artery grafting was the only means of obtaining revascularization, but the surgical procedure has significant pathological alterations (incidence of graft vessel thrombosis and nephrectomy 1.5% to 4.5%) and a postoperative morbidity and mortality rate of 2% to 3%. Since 1978 Gruentzig et al. applied balloon angioplasty has become an alternative surgical treatment with the same surgical results and fewer complications. Showing a high recanalization rate and satisfactory results, the other reason why arterial balloon angioplasty is not satisfactory in patients whose renal blood flow is blocked by a renal artery plaque is that the lesion has a hard or elastic retractable component. This leads to a lower success rate (24% to 35%) and a higher restenosis rate (>65%), so surgical treatment should be insisted on for this type of lesion. Other limitations of balloon angioplasty are complete failure or failure to achieve optimal results, including anatomic occlusion and short- to medium-term restenosis, both of which depend directly on the type of pathology and the site of stenosis. In recent years, the use of renal artery stenting, which overcomes the limitations of balloon angioplasty, self-expanding stents, and more often balloon-expanding stents have been applied to the femoral or brachial artery, and several types of stents have been used in clinical practice. The recently used Palmaz stent can be properly implanted at the site of occlusion and can be expanded at higher pressures to achieve the desired diameter. The use of self-expanding stents is difficult because of their retracting properties along the long axis after placement. Technical considerations The stent placement technique is very similar to that of coronary artery placement stenting. The length of the stent is required to be 10-20 mm, and the stent needs to be delivered with a balloon catheter with a slightly larger expansion diameter (10%-15%) than the reference diameter, and the changes before and after the procedure are recorded and the results are compared by contrast images. Careful consideration must be given to stent placement of the lesion at the opening, with the contrast catheter passing through the contralateral femoral artery so that the contrast images can accurately determine the stent position and allow the stent to adequately cover the plaque. From published reports, stent placement improves the immediate effect after balloon angioplasty by reducing the pressure step difference of the balloon. Recent studies have shown that serious complications are rare or even absent. In the report of White et al, 149 patients underwent surgery, one of them had thrombosis but did not require surgery, and Harden et al reported 3 out of 32 cases with bleeding that required hemodialysis treatment. In accordance with recent studies, post-interventional treatment has been changed, with patients in Harden’s series routinely receiving low-dose aspirin without other anticoagulants; White et al and Dorros et al put patients on warfarin for 1 to 3 months, resulting in prolonged clotting time titers up to 2.0 to 2.5 times the international normalized ratio (INR). Clinical benefits Based on clinical and angiographic data, it is much like PTCA, showing that the more complete the vasodilation, the larger the minimum lumen diameter after angiography. Recent studies have found restenosis (residual stenosis >50%) rates of 11% to 25%. The results of vascular opening are varied, although lacking with prospective randomized studies. Harden et al. reported that renal artery stenting significantly delayed the progression of renal failure, thereby prolonging the time to mandatory hemodialysis. Serum creatinine levels improved or remained stable in about 55% of patients, and Blume et al. reported no significant change in serum creatinine levels after successful stent placement in patients with pre-existing renal impairment, but no deterioration, suggesting that stent placement protects renal function. similar results were reported by Dorros, with 78% of patients having improved or stable serum creatinine levels. This is clinically important, as it is known that untreated renal artery stenosis may be worsened by renal artery occlusion, with a reduction in kidney volume and consequent decrease in renal function. The long-term outcomes of blood pressure normalization and improved renal function are contradictory, with Blum et al. reporting blood pressure normalization in 16% of patients and improvement in 62%, while Dorros et al. and White et al. reported a significant decrease in blood pressure and a decrease in antihypertensive medication use in the entire surgical population (p<0.001). The effect of intervention on the blood pressure of patients with renal failure who had not reduced their postoperative antihypertensive medication was minimal, with no further changes in blood pressure beyond 3 months after surgery. Future Directions Stent placement has good immediate results, a low complication rate and satisfactory restenosis rates, with favorable long-term effects on renal arteries and blood pressure. Systemic stenting is advocated for open stenoses, which have a tendency to elastically retract to their initial state after balloon angioplasty, for non-open stenoses, where the indication for stenting is the possibility of residual stenosis, and for unilateral or bilateral renal lesions where the indication for stenting is lenient. Multicenter studies may be needed to evaluate the indications and benefits of application in different clinical and anatomical situations.