Optimal management of renal artery stenosis has continued to remain elusive. The previous non randomized studies and registry data suggested a benefit of renal artery stenting. However, the recently completed randomized studies comparing renal stenting to medical management failed to show any benefit. These studies had some flaws in their design and methodology. In an appropriately selected patient population renal artery stenting may have a role. In addition, there might be some role of adjunctive therapies like antiplatelet medications and embolic protection. This review summarizes the current literature on this controversial topic.