Abstract
BACKGROUND: Calcified lesions represent a hard obstacle to overcome in renal arteries, particularly when renal angioplasty represents the only feasible course of action in the setting of high-risk bilateral renal artery stenosis (RAS) with refractory systemic hypertension and recurrent flash pulmonary oedema. CASE SUMMARY: We herein report a case of symptomatic bilateral severely calcified RAS, treated successfully with intravascular ultrasound (IVUS)-guided coronary and peripheral intravascular shockwave lithotripsy systems and stenting. DISCUSSION: Intravascular shockwave lithotripsy is an attractive modality for the treatment of challenging, heavily calcified renal arteries that combines the calcium-disrupting capability of lithotripsy with the familiarity of balloon catheters to facilitate proper stent deployment.