A 62-year-old man, a heavy smoker, was admitted with resistant hypertension. He had been a known hypertensive for >10 years; the highest systolic and diastolic blood pressure was 220 and 140 mmHg, respectively. Treatment with oral calcium channel blocker, beta blockers, and diuretics had not controlled the blood pressure. Other medical history included new-onset diabetes for the last 2 months and hyperlipidaemia and coronary heart disease for the last 10 years. No abdominal and cardiovascular abnormalities were found. Conn’s syndrome was excluded by negative aldosterone screening in horizontal position and no abnormal adrenal CT scan. The creatinine level was 84.3 µmol/L (44–133 µmol/L). Renal artery US showed a peak systolic velocity of 358 cm/s, indicating severe stenosis of the right renal artery. Renal artery CTA showed local and ostial stenosis (95%) of the right renal artery. RAG showed 95% ostial stenosis of the right renal artery using a 6 F RDC catheter. The stenosis was pre-dilated with a 4 × 20 mm balloon (Sapphire) at a maximal pressure of 18 atm and implanted with a 6 × 14 mm stent (Express SD) at a maximal pressure of 15 atm through a Fielder guided wire. The intervention was successful without any complications. Dual antiplatelet therapy was then administered (aspirin 100 mg, one time daily, clopidogrel 75 mg, one time daily). After 3 days, the patient developed sudden right lower abdominal pain. The abdominal and renal examination was negative, but defaecation had stopped. The electrocardiogram, myocardial enzyme levels, and myocardial infarction marker levels were all normal. Pancreatitis was excluded because the amylase levels were normal. The serum creatinine level increased slightly, to 100–108 µmol/L, the urine protein was weakly positive (+1), and the blood pressure was maintained at 110/70 mmHg. To determine the cause of abdominal pain, renal artery US was performed, which showed that the main trunk of the right renal artery was not clear, and the blood flow was significantly reduced. This indicated a possible complication of right renal artery stenting. Renal artery CTA showed an unobstructed right renal artery stent, a severely stenosed middle segment, and light right renal perfusion. Considering a diagnosis of thrombosis or dissection of the renal artery, treatment with low-molecular weight heparin anticoagulant and rehydration was administered. Simultaneously, examining the dual glomerular filtration rate (GFR) using nuclear imaging discovered a non-functional right kidney (GFR: right 0.6; left 75.6; Figure ). Therefore, RAG was repeated to identify the cause of blood flow reduction and rescuing kidney function; the right renal artery stent was found patent. Severe stenosis (90–95%) of the middle part of the renal artery with two branches involved was seen; however, there was no dissection or thrombus formation. To further determine the aetiology of the new lesion, IVUS was used, which showed that the IMH originated at the distal end of the stent, without an identifiable entry point, and the length was about 40 mm. After clarifying the cause of the new stenosis, we first used a 2.5 × 20 mm balloon, followed by a 4 × 20 mm balloon (Sapphire) at a low pressure to push out the haematoma and dilate the compressed renal artery from the proximal to the distal end. The cavity of the compressed renal artery increased gradually, and the blood flow improved. However, the residual stenosis was still more than 50%, limiting the blood flow. Therefore, another stent (5 × 19 mm Express SD) was implanted near the first stent; the distal segment of the renal artery was seen to be well-developed. After reoperation, dual GFR revealed that the right kidney function had partially recovered (GFR: right 10.3; left 66.3; Figure ), the creatinine reduced to 91 µmol/L, and the urine protein was negative. After discharge, the patient continued to maintain dual antiplatelet therapy. At the third month follow-up, the abdominal pain symptoms had disappeared, the serum creatinine level was 79 µmol/L, the urine protein was negative, and the blood pressure was maintained at 125/83 mmHg without any antihypertension drug. Renal artery US showed that the right renal artery was unobstructed.