Atherosclerosis accounts for most adult cases of renal artery stenoses (RAS). Revascularization of atherosclerotic RAS is beneficial in terms of improved blood pressure control, preservation of renal function and overall decrease of cardiovascular risk, in particular in mononephric patients. Endovascular stenting has been proven superior to percutaneous transluminal angioplasty (PTA) alone in terms of initial success and restenosis rates in atherosclerotic RAS. In this case report revascularization of atherosclerotic RAS in a mononephric patient is presented and the long-term follow-up and complications of PTA and stenting are illustrated. Our case is the first report of fracture of a sirolimus-eluting stent overlapped to a previously implanted Palmaz–Schatz in the left renal artery. The mechanisms and possible remedies of this complication are discussed.