https://doi.org/10.4081/ecj.2026.14834
Flash pulmonary edema and resistant hypertension due to renal artery in-stent restenosis: a case report
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Published: 20 July 2026
Renal artery in-stent restenosis is an uncommon but serious cause of resistant hypertension and flash pulmonary edema. We present the case of a 75-year-old woman with extensive multidistrict atherosclerosis and a history of multiple endovascular procedures, who presented to the emergency department with recurrent pulmonary edema due to uncontrolled hypertension. Despite maximal antihypertensive therapy, her blood pressure remained severely elevated, with evidence of acute kidney injury. Doppler ultrasound revealed restenosis of the right renal artery stent, characterized by a tardus-parvus waveform, along with an atrophic left kidney. The patient underwent successful right renal artery lithotripsy and stenting, resulting in restoration of renal perfusion and subsequent improvement in blood pressure control and pulmonary congestion. In patients with resistant hypertension and recurrent flash pulmonary edema, prompt recognition of renal artery stenosis, the so-called Pickering syndrome, or in-stent restenosis as in the present case, and timely endovascular reintervention can be lifesaving.
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CRediT authorship contribution
Rosa Di Donato, patient management, clinical data collection, and drafting of the case report; Sara Speziali, endovascular management of the patient and drafting of the section related to the interventional procedure; Francesca Caldi, clinical management and data collection. Francesca Innocenti, clinical management and contribution to manuscript drafting; Lorenzo Pelagatti, clinical management and literature review; Raffaele Pulli, critical revision and final approval of the vascular management section; Simone Vanni, clinical management, literature review, critical revision, and final approval of the manuscript.
Data Availability Statement
All data underlying the findings are fully available.
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