【】Objective? To investigate the significance of real-time contrast-enhanced ultrasound to analyze the changes of renal blood perfusion in patients with severe atherosclerotic renal artery stenosis after stenting (PTRAS). Methods A retrospective analysis was performed on 83 patients with severe atherosclerotic renal artery stenosis with PTRAS values in our hospital from February 2020 to February 2024. The changes of blood pressure, renal function indexes, renal aorta blood flow parameters and renal blood perfusion parameters detected by real-time contrast ultrasound before and after surgical treatment were analyzed. The relationship between the changes of each index and renal function index was analyzed. ? Results After operation, PSV, EDV and AT values of renal aorta and interlobar artery were significantly decreased compared with before operation, with statistical significance (P<0.05), while PSV, RI and AC values of renal interlobar artery were significantly increased compared with before operation, with statistical significance (P<0.05). After operation, the TTP and MTT values of patients with atherosclerotic renal artery stenosis were significantly decreased by PTRAS examination, the difference was statistically significant (P<0.05), and the PI and S values were significantly increased after operation compared with those before operation, the difference was statistically significant (P<0.05). After operation, the systolic blood pressure, Scr and uric acid levels of patients with atherosclerotic renal artery stenosis were significantly decreased, the difference was statistically significant (P<0.05), and the eGFR measured value was significantly increased after operation compared with that before operation, the difference was statistically significant (P<0.05). In patients with atherosclerotic renal artery stenosis before operation, the values of PSV and EDV in renal aorta and AT in interlobar arteries were significantly negatively correlated with eGFR (P<0.05), while the values of PSV, RI, and AC in interlobar arteries were significantly positively correlated with eGFR (P<0.05). In patients with atherosclerotic renal artery stenosis, renal perfusion parameters TTP and MTT were negatively correlated with eGFR (P<0.05), interlobar artery PI and S were positively correlated with eGFR (P<0.05).? Conclusion Contrast-enhanced ultrasound can accurately evaluate the changes of renal blood perfusion level in patients with severe atherosclerotic renal artery stenosis before and after treatment, and the perfusion level has a certain correlation with the degree of renal dysfunction.