[1] Most cases of renal artery stenosis are asymptomatic, and the main problem is high blood pressure that cannot be controlled with medication.

[7] The pathophysiology of renal artery stenosis leads to changes in the structure of the kidney that are most noticeable in the tubular tissue.

The first treatment of renovascular lesions by percutaneous catheter angioplasty (PTA) was performed in 1978 by Andreas Roland Grüntzig.

The ASTRAL trial [18] randomized 806 patients to renal artery revascularization via stenting versus medical therapy, with the following results: The CORAL study [19] randomized 947 patients to stenting versus medical therapy, with a primary endpoint of major cardiovascular or renal events.

Collectively, the evidence so far does not support renal artery stenting as a proper mainstay treatment for stenosis because it conveys no survival benefit, no true renoprotection, and does not decrease the need for antihypertensive medications.

Smoking cessation and thoughtful blood pressure control, via lifestyle/dietary changes and medication, are the current mainstays of managing renovascular hypertension.