A 55 year old woman with normal kidney function is referred to you with a 3 year history of increasing difficult to control hypertension. Over the last 6 months her blood pressure has deteriorated and she is complaining of worsening headaches and pulsatile tinnitus. She is on maximal doses of amlodipine, ramipril, atenolol and bendroflumethazide. She is a non-smoker
Examination reveals a BP of 190/100 in her left arm and 150/90 in her right arm, bilateral carotid bruits and a subclavian bruit. Rest of the examination was unremarkable.
Urinalysis and kidney function are normal. She undergoes a MRA followed by an angiogram of her renal arteries as shown below.
What is the most likely diagnosis?