Treatment of Uncomplicated Acute Aortic Dissection Not Involving the Ascending Aorta (Stanford Type B)
This protocol covers the initial management of acute thoracic aortic dissection confined to the aorta distal to the ascending segment (Stanford type B) in the uncomplicated setting — where there is no rupture, no branch artery occlusion or malperfusion, no extension of the dissection, and no aortic enlargement.
Clinical scenario: Stanford type B is defined as all dissections that do not involve the ascending aorta, including dissections that involve the aortic arch but spare the ascending aorta. The uncomplicated designation requires the absence of rupture, malperfusion, dissection extension, and aortic enlargement.
Hemodynamic targets: Systolic blood pressure below 120 mm Hg (or the lowest blood pressure that maintains adequate end-organ perfusion), and heart rate of 60 to 80 bpm.
Medical therapy is recommended as the initial management strategy for all patients with uncomplicated acute type B aortic dissection. The approach centres on anti-impulse therapy administered with invasive blood pressure monitoring in an ICU setting, aimed at reducing aortic wall stress — followed by a transition to long-term oral therapy to sustain hemodynamic control.
The complete structured regimen, including the full agent selection, escalation sequence, and criteria for each step, is available in the full protocol.
References
Type B: All dissections that do not involve the ascending aorta (including dissections that involve the aortic arch but spare the ascending aorta)
In all patients with uncomplicated acute type B aortic dissection, medical therapy is recommended as the initial management strategy.
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.
DOI: 10.1161/CIR.0000000000001106
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