A 68-year-old man with hypertension presents with sudden severe tearing chest pain radiating to the back. CT aortography shows an intimal flap in the ascending aorta extending into the descending aorta. According to the Stanford classification, this is:

• A Stanford Type B — managed medically unless complications arise
• B DeBakey Type III — requires TEVAR
• C DeBakey Type I — managed medically
• D Stanford Type A — requires emergency surgery ✓

Explanation

Stanford Type A dissection involves the ascending aorta regardless of the extent of dissection, and this carries a mortality of ~1–2% per hour without surgery. Emergency surgical repair (replacement of the ascending aorta) is the standard of care. Stanford Type B involves only the descending aorta (distal to left subclavian) and is managed medically unless complicated by malperfusion, rupture, or rapid expansion. DeBakey Type I involves both ascending and descending; Type II is ascending only; Type III is descending only.

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

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Written and medically reviewed by the StethoPrep medical team.