Unilateral Renal Denervation for Refractory Hypertension in Aortic Dissection

Refractory hypertension in patients with aortic dissection represents an extreme therapeutic challenge, as these patients are typically excluded from renal denervation (RDN) trials due to prohibitive procedural risks.

A 40-year-old man with refractory hypertension complicated by a chronic DeBakey Type III (Stanford Type B) aortic dissection and abdominal aortic aneurysm presented with blood pressure of 171/98 mm Hg despite quintuple therapy. Unilateral right-sided RDN was performed using a multielectrode catheter, delivering 24 ablation lesions. Postprocedure, systolic blood pressure decreased by 30 mm Hg, enabling discontinuation of 2 antihypertensive agents.

This case demonstrates that unilateral RDN is safe and effective in patients with extreme vascular lesions where bilateral RDN is not suitable. The marked blood pressure response suggests heightened sympathetic drive in this population.

RDN is also feasible for patients with aortic dissection, and even unilateral RDN can achieve a blood pressure-lowering effect. These findings are hypothesis-generating and require prospective validation.