A 55-year-old male presents with tearing chest pain radiating to his back. CT angiography reveals an intimal flap in the ascending aorta. What is the immediate treatment of choice?
Answer and explanation
Correct answer: D. Emergent surgical repair
- Step 1: Involvement of the ascending aorta defines a Stanford type A aortic dissection.
- Step 2: Stanford type A dissections carry high mortality from rupture, pericardial tamponade, or coronary ostial occlusion and require emergent surgical graft repair.
Answer
Emergent surgical repair.
Why not the others: Medical therapy alone is the initial strategy for uncomplicated Stanford type B dissections involving only the descending aorta. Thrombolysis is strictly contraindicated in aortic dissection and can precipitate fatal exsanguination. Anticoagulation increases the risk of propagation and fatal pericardial rupture.
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