Performing endovascular interventions such as stent placement is notoriously difficult in patients who have advanced renal artery stenosis with severe calcification, and these patients are at risk of unfavorable outcomes from stent expansion. Intravascular lithotripsy, a recently developed clinical tool that uses shockwaves to break up calcified plaques, is a promising approach for making endovascular interventions safer and more effective. We present the case of an 85-year-old woman with refractory hypertension who presented with Pickering syndrome (recurrent flash pulmonary edema secondary to renal artery stenosis) and ischemic nephropathy. Imaging, angiography, and intravascular ultrasonography revealed severe bilateral ostial renal artery stenosis within the context of significant calcification of the left renal artery ostium. Shockwave intravascular lithotripsy was used before successful stent placement, and the patient had a complication-free recovery. This case outlines a hallmark treatment approach for utilizing intravascular lithotripsy to improve the arterial physiological space for stent placement.