Emergency Care Journal · Published 2026-07-20 · DOI 10.4081/ecj.2026.14834
Rosa Di Donato, Sara Speziali, Francesca Caldi, Francesca Innocenti, Lorenzo Pelagatti, Raffaele Pulli, Simone Vanni
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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Donato, R., Speziali, S., Caldi, F., et al. (2026). Flash pulmonary edema and resistant hypertension due to renal artery in-stent restenosis: a case report. Emergency Care Journal. https://doi.org/10.4081/ecj.2026.14834