From the Guidelines
Aortic dissection treatment requires immediate medical attention, focusing on controlling blood pressure and heart rate to prevent further tearing of the aorta, with beta-blockers as the first-line medication, as recommended by the most recent guidelines 1. The initial management of thoracic aortic dissection should be directed at decreasing aortic wall stress by controlling heart rate and blood pressure.
- Beta-blockers such as metoprolol, labetalol, or esmolol are first-line medications to reduce heart rate and blood pressure, with a target heart rate of 60 beats per minute or less, as stated in the 2010 guidelines 1.
- If blood pressure remains elevated, vasodilators like nicardipine or nitroprusside may be added, but only after beta-blockers are started to avoid reflex tachycardia, as recommended by the 2019 position document on the management of hypertensive emergencies 1.
- Pain management with opioids like morphine is also essential, and for type A dissections (involving the ascending aorta), emergency surgery is typically necessary to prevent rupture, cardiac tamponade, or severe aortic regurgitation.
- Type B dissections (limited to descending aorta) may be managed medically unless complications like organ malperfusion, rupture, or uncontrollable pain occur, with thoracic endovascular aortic repair (TEVAR) recommended as the first-line therapy for complicated cases, as stated in the 2024 guidelines 1. The management of aortic dissection is crucial, as it has a high mortality rate if not promptly and appropriately treated, with the risk of aortic rupture being the primary concern, highlighting the importance of following the most recent and highest quality guidelines, such as those from the European Society of Cardiology 1.
From the Research
Treatment Overview
The treatment for aortic dissection depends on the type and severity of the dissection.
- Medical therapy with aggressive blood pressure lowering is recommended for patients with acute aortic dissection, when they are not indicated for emergency surgery 2.
- Patients with aortic dissection without ascending aorta involvement (Stanford type B) are typically treated medically, unless they have fatal complications 2.
Surgical Intervention
- Surgical treatment is generally reserved for patients with complications, such as persistent symptoms, malperfusion, enlarging aneurysms, and impending rupture 3.
- Thoracic endovascular aortic repair is recommended for patients with complicated type B aortic dissection 2.
- Immediate surgical repair is necessary for aortic dissection involving the ascending aorta 4.
Medical Management
- Beta-blockers are commonly used as first-line therapy to decrease aortic wall stress in patients with chronic type B aortic dissection 5.
- Other antihypertensive medications, such as calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers, may also be used 5.
- Ultrashort-acting beta-blockers, such as esmolol, may be useful in patients with compromised cardiac function or bronchospastic disease 6.
- Sodium nitroprusside is also used to control blood pressure in patients with acute aortic dissection 6, 4.