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Uncomplicated Type B Aortic Dissection — EECC MCQ

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ModerateAortic DiseaseUncomplicated Type B Aortic DissectionEECC

A 68-year-old man with hypertension presents with sudden-onset interscapular pain. CT aortography shows an uncomplicated acute type B aortic dissection with the false lumen extending from the left subclavian artery to the iliac bifurcation. All branch vessels are perfused from the true lumen. BP is 175/100 mmHg, HR 85 bpm. There are no signs of malperfusion. What is the recommended initial management?

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Correct answer: A — Aggressive medical therapy with IV beta-blocker targeting HR <60 bpm and SBP 100-120 mmHg

Uncomplicated acute type B aortic dissection (Stanford B, DeBakey III) is managed with optimal medical therapy (OMT) as the primary strategy (Class I). The goal is to reduce aortic wall shear stress by controlling heart rate (<60 bpm) and blood pressure (SBP 100-120 mmHg) using IV beta-blockers (labetalol or esmolol) as first-line. Surgical or endovascular intervention (TEVAR) is reserved for complicated type B dissection (malperfusion syndrome, rupture or impending rupture, refractory pain, rapid aortic expansion). The INSTEAD-XL trial showed TEVAR improved long-term aortic remodelling and survival in the subacute phase, but acute uncomplicated type B dissection should initially be managed medically.

Reference: ESC (2024): Guidelines for the Management of Peripheral Arterial and Aortic Diseases