A 61-year-old man (height 181 cm, weight 110 kg) presented to our clinic with dyspnoea (NYHA Class II) and progressive chest and abdominal pain. Medical history included an aortic dissection type B with perfusion of the left kidney from the false lumen, diagnosed in 2009 (Figure 1A and Figure 1B). The patient was receiving five antihypertensive drugs (bisoprolol 5 mg 1⁄2-0-1⁄2, hydrochlorothiazide 25 mg 1-0-0, amlodipine 10 mg 1-0-0, urapidil 90 mg 1-0-1, moxonidine 0.3 mg 1-0-1). Office blood pressure (BP) was 160/95 mmHg. Ambulatory 24-hour BP monitoring confirmed true treatment resistance (mean 141/91 mmHg, non-dipping pattern). Renal denervation was performed via femoral access. An 8 Fr IMA guiding catheter (Cordis, Johnson & Johnson, Warren, NJ, USA) was placed into the true aortic lumen at the level of the left renal artery. After a fenestration manoeuvre of the intima flap, performed using an IRON MAN PTCA wire (Abbott Vascular, Redwood City, CA, USA), the SymplicityTM radiofrequency catheter (Medtronic Inc., Minneapolis, MN, USA) was introduced and advanced to the distal segment of the renal artery under fluoroscopy (Figure 1C and Figure 1D, Moving image 1 and Moving image 2). Five treatments of the left artery and six of the right artery were successfully applied. At three and six-month follow-up, ambulatory 24-hour BP was reduced by 13/10 mmHg and 14/9 mmHg (mean daytime 130/83 mmHg; mean night-time 122/79 mmHg), respectively (Online Figure 1). Six months after treatment, BP was controlled to target (office 130/90 mmHg). MRA showed no sign of complications at six-month follow-up.