Symptomatic mesenteric circulatory disorders are potentially life-threatening diseases with an increasing frequency due to the demographic population development. Renal artery stenosis is a well accepted cause of hypertension or at least deterioration of blood pressure control as well as the cause of a progressive course of renal insufficiency if of an atherosclerotic nature. Further consequences of renal artery stenosis, such as left ventricle hypertrophy and hypertensive encephalopathy are topics of recent research. Due to progress in percutaneous techniques during the last decade interventional therapy has replaced surgery as the treatment method of choice for lesions located near the origin. The only randomized study comparing endovascular stent revascularization with best medical therapy (ASTRAL) failed to show a benefit of revascularization of renal artery stenoses.