A 65-year-old hypertensive man presents with tearing chest pain radiating to the back. CT aortogram shows an intimal flap in the ascending aorta. According to Stanford classification, which type is this and what is the primary management?

• A Type B — managed medically with blood pressure control
• B Type B — TEVAR indicated as first line
• C Type A — TEVAR indicated due to endovascular availability
• D Type A — emergency surgical repair ✓

Explanation

Stanford Type A aortic dissection involves the ascending aorta (regardless of where the dissection originates). It carries a mortality of 1–2% per hour untreated and mandates emergency open surgical repair to prevent retrograde coronary artery involvement, cardiac tamponade, and aortic regurgitation. Stanford Type B involves only the descending aorta (distal to left subclavian) and is managed medically unless complicated (malperfusion, rupture, rapid expansion), in which case TEVAR is used. TEVAR has no role in primary Type A dissection.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.