Stanford Type A aortic dissection encompasses all dissections involving the ascending aorta, regardless of where the intimal tear originates. It carries an early mortality of 1% to 2% per hour after symptom onset in symptomatic patients left untreated, making prompt haemodynamic intervention the immediate clinical priority.

Clinical scenario

Requires prompt action

The patient presents with acute aortic dissection involving the ascending aorta (Stanford Type A). The goal of initial management is to reduce aortic wall stress and limit propagation while the patient is assessed for definitive treatment.

Initial management approach (partial)

Management begins with prompt anti-impulse therapy in an ICU setting, with continuous invasive blood pressure monitoring via an arterial line. Intravenous agents are used to bring heart rate and systolic blood pressure into target range — the complete selection of first-line agents, alternatives for patients with contraindications, and adjunctive supportive measures are detailed in the full protocol.

Haemodynamic targets

Systolic blood pressure <120 mm Hg (or the lowest BP that maintains adequate end-organ perfusion) and heart rate of 60 to 80 bpm.

References

DOI: 10.1161/CIR.0000000000001106

Type A: All dissections involving the ascending aorta, irrespective of the site of the intimal tear.

Acute aortic dissection of the ascending aorta is highly lethal in symptomatic patients left untreated, with an early mortality of 1% to 2% per hour after symptom onset.

In patients presenting to the hospital with AAS, prompt treatment with anti-impulse therapy with invasive monitoring of BP with an arterial line in an ICU setting is recommended as initial treatment to decrease aortic wall stress.

Patients with AAS should be treated to an SBP <120 mm Hg or to lowest BP that maintains adequate end-organ perfusion, as well as to a target heart rate of 60 to 80 bpm.

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Treatment of Acute Aortic Dissection Involving the Ascending Aorta (Stanford Type A)

References