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Aortic dissection (AD) is an exceedingly rare complication in this specific context, particularly involving the descending aorta. We describe a case of a 46-year-old Caribbean-Black male with a medical history of chronic hypertension (HTN) who presented with unstable angina and hypertensive crisis. Emergent computed tomography angiography revealed critical proximal descending CoA with poststenotic dilatation and an acute Stanford type B AD. He was initially stabilized on guideline-directed medical therapy, and while definitive surgical repair was recommended, the patient declined. This exceedingly rare case of type B AD complicating unrepaired CoA underscores the importance of recognizing congenital aortic disease as a cause of refractory HTN in adults. Additionally, it highlights the need for continued vigilance for long-term complications in adults with congenital heart disease.<\/jats:p>","DOI":"10.1177\/23247096261416280","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:32:29Z","timestamp":1769589149000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stanford Type B Aortic Dissection in an Adult Patient With Unrepaired Coarctation of the Aorta"],"prefix":"10.1177","volume":"14","author":[{"given":"Priya","family":"Ramcharan","sequence":"first","affiliation":[{"name":"North Central Regional Health Authority, Mt Hope, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0401-1918","authenticated-orcid":false,"given":"Arun","family":"Katwaroo","sequence":"additional","affiliation":[{"name":"North West Regional Health Authority, Port of Spain, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Maharaj","sequence":"additional","affiliation":[{"name":"North Central Regional Health Authority, Mt Hope, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valmiki","family":"Seecheran","sequence":"additional","affiliation":[{"name":"North Central Regional Health Authority, Mt Hope, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Pereira","sequence":"additional","affiliation":[{"name":"North Central Regional Health Authority, Mt Hope, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Chan","sequence":"additional","affiliation":[{"name":"North Central Regional Health Authority, Mt Hope, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev","family":"Seecheran","sequence":"additional","affiliation":[{"name":"University of New Mexico Medical Center, Albuquerque, NM, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9838-7148","authenticated-orcid":false,"given":"Neal","family":"Bhagwandass","sequence":"additional","affiliation":[{"name":"University of the West Indies, St Augustine, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7779-0181","authenticated-orcid":false,"given":"Naveen","family":"Seecheran","sequence":"additional","affiliation":[{"name":"University of the West Indies, St Augustine, Trinidad and Tobago"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1505269"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.4330\/wjc.v12.i5.167"},{"issue":"1","key":"e_1_3_2_4_2","article-title":"Coarctation of the aorta with some collaterals presenting as aortic dissection detected by 64-MDCT","volume":"5","author":"Shiga Y","year":"2012","unstructured":"Shiga Y, Miura SI, Kumagai N, et al. 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