In this video, a patient with previously treated renal artery stenosis presents with medically refractory hypertension. Renal arteriogram is indicative of instent intimal hyperplasia in the left renal artery. This radiologic finding is confirmed with physiologic pressure gradients between the renal artery and the abdominal aorta.

A new stent and instent balloon dilation is the therapeutic intervention with confirmation of therapeutic success through repeat gradient measurements. A final nephrogram and aortogram are performed prior to closure to ensure no iatrogenic consequences of the procedure.