Introduction: The last European guideline on periphe-ral artery diseases considers renal angioplasty worse than medical treatment in most renal artery stenosis cases. We show that renal angioplasty is useful in symp-tomatic renal artery stenosis

Methods: Case presentation – 2 eloquent cases. Results: Case 1 – 64 years old male patient with multivascular disease (carotid, iliac and renal arteries), but without coronary artery involvement and with normal LV function and no significant valve disease is treated for iterative hypertensive acute pulmonary edemas des-pite of intensive medical treatment. Bilateral renal an-gioplasty with stent solve immediately the problem: the patient become normotensive without new pulmonary edema. Case 2 – 63 years old male patient with previo-us cystectomy for urinary bladder cancer and bilateral percutaneous ureterostomy presented for recent onset of high blood pressure associated with severely reduced right kidney urinary excretion (seen in the right ureterostomy bag). Isolated right artery stenosis is treated by angioplasty with stent and resulted in spectacular improvement of hypertension and equalization of both kidney excretion.

Conclusions: Despite the diminished role given by actual practice guidelines, renal angioplasty is essential in renal artery stenosis treatment in certain cases. The selection of appropriate cases is critical for elimination of those situation in which renal artery stenosis is not the cause of hypertension or the kidney is already com-promised.