Aim To evaluate the efficacy of intravascular ultrasound (IVUS) in patients undergoing renal artery intervention therapy. Methods 15 consecutive patients with significant renal artery stenosis (luminal narrowing of renal artery > 50%) underwent IVUS, before and after renal artery stenting. All patients underwent renal artery stenting, the sizes of the stent were chosen according to the results of IVUS. Results IVUS revealed 13 hard plaques with 2 severe calcification and 2 soft plaques in 15 patients; 12 lesions were found with negative remodeling, 3 with positive remodeling. The mean cross sectional areas of external elastic membrane and lumen were 119.7±23.1 mm 2 and 34.5±9.3 mm 2. The mean plaque area was 85.2±26.0 mm 2. All patients underwent renal artery stenting with 100% successful procedure rates. Conclusions IVUS has superiority in determining the lesion characteristics, defining the stenosis, calculating the luminal dimension and inserting the stent.