Thirty-five patients diagnosed with aldosterone-producing adenomas (APAs) underwent computed tomography (CT)-guided percutaneous microwave ablation (MWA). Comparisons of aldosterone-to-renin ratio, potassium level, blood pressure (BP), and medications were performed preprocedurally, postprocedurally, and at the latest follow-up examination. The outcome assessment was based on the Primary Aldosteronism Surgical Outcome (PASO) standards. Hypokalemia was corrected in all patients. The BPs postprocedurally and at the latest follow-up (138 [128-152]/85 [75-95] mm Hg and 130 [120-140]/85 [80-90] mm Hg, respectively) were significantly lower than preprocedural BP (156 [149-170]/100 [90-106] mm Hg). The number of antihypertensive medications was reduced from 3 (2-3) to 1 (0-1). The biochemical outcomes were 89% complete success (CS), 7% partial success (PS), and 4% absent success (AS). The clinical outcomes were 37% CS, 60% PS, and 3% AS. Hypertensive crisis occurred in 20%, controlled by α-adrenergic blockade. CT-guided percutaneous MWA is an effective treatment for APA with biochemical and clinical outcomes comparable to adrenalectomy by PASO standards.