Backgound: Renal artery stenosis (RAS) is a major cause of renovascular hypertension and reduced renal function due to ischemic atropy of kidney. Few datas have detailed the safety, efficacy, and long-term clinical benefits of direct stent implantation in aorto-ostial atherosclerotic RAS lesion. This study sought to define the long-term results of direct renal stenting without predilation in patients with aorto-ostial atherosclerotic RAS lesion. Methods: This study enrolled 20 patients (male 15, mean age 62.7짹14.3) with de-novo >75% aorto-ostial renal artery stenosis, who underwent implantation of a balloon-expandable stent without predilation. Renal artery stentings were performed via right femoral artery in 18 cases and brachial artery in 2 cases. Follow-up was performed by renal duplex US, renal angiogram and clinical examination. Results : The stent procedure was immediately successful in all patients. The degree of renal artery stenosis was 84.8짹9.9%. The used renal stents were all Genesis stent (Cordis, U.S.A.). Mean stent size was 6.1짹0.87 mm and length was 18.6짹5.7 mm. The transstenotic pressure gradients after renal artery stenting was decreased markedly (p<0.001). There was no serious complications such as a death, emergent surgery, acute renal failure or nephrectomy. There was one minor complications which was minor renal artery dissection after procedure. After procedure, systolic blood pressure (BP) was decreased from 156.3짹24.7mmHg to 134.4짹29.0 mmHg (p=0.005) and diastolic BP was decreased from 93.7짹15.8 mmHg to 77.6짹13.3 mmHg (p=0.012). Mean serum creatinine concentration was decreased from 1.44짹0.75 mg/dL to 1.24짹0.58 mg/dL (p=0.032). There was no critical events during the 35 months follow-up period. In-stent restenosis data is under investigating. Conclusion: In hypertensive patients with aorto-ostial renal artery stenosis in whom direct renal stenting is provide a safe and effective revascularization strategy.