A 61-year-old man has sudden tearing chest pain radiating to the back. CT angiography shows an intimal tear beginning 2 cm above the aortic valve with extension into the descending thoracic aorta. Blood pressure is controlled. What is the definitive next step?

• A Continued intravenous beta-blockade alone
• B Urgent surgical repair ✓
• C Thoracic endovascular aortic repair only if pain persists
• D Serial imaging every six months

Explanation

An ascending aortic dissection is a Stanford type A (DeBakey type I when it extends distally), and all type A dissections require urgent open surgical repair because of the risks of hemopericardium, aortic regurgitation, coronary ostial compromise, and stroke. Medical therapy alone is appropriate only for uncomplicated Stanford type B dissections confined to the descending aorta.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.