Renal artery stenosis (RAS) is a common disease that endangers human health, usually caused by atherosclerosis or fibromuscular dyspalsia. RAS is also one of the most common causes of secondary hypertension, often leading to resistant hypertension with markedly elevated renin levels and early onset of progressive renal insufficiency. In addition, the activation of renin-angiotensin-aldosterone system (RAAS) caused by RAS and pathophysiological changes including glomerular sclerosis and atrophy, water and sodium retention can also lead to cardiovascular events such as heart failure, pulmonary edema, coronary heart disease and cerebral infarction. Therefore, early recognition of RAS and prompt revascularization in patients with severe stenosis are key to the treatment of RAS. Percutaneous renal artery stenting (PRAS) has become the preferred revascularization for patients with RAS due to its high response rate, minimally invasiveness, fast recovery and low restenosis rate. However, there are still some unavoidable complications of PRAS, such as aortic dissection, renal artery rupture, puncture vascular aneurysm, contrast allergy and contrast-induced nephropathy. The occurrence of these complications may have adverse consequences for patients, and even death in severe cases. Renal arteriovenous fistula is a very rare complication of PRAS, and clinical experience in its recognition and management is very limited. Few cases that can be collected tend to favor re-surgical intervention. But surgical intervention undoubtedly increases the risk of patient suffering and mortality again. Thus, it is of great significance to summarize such complications and give a scientific recommendation to clinicians. This article reports a patient with resistant hypertension who underwent renal arteriography showing severe stenosis of renal vessels and developed a renal arteriovenous fistula after stent implantation. Therefore, it is worth considering whether the renal arteriovenous fistula caused by PRAS should be treated with surgical intervention or conservative medical treatment.