Need for and update on clinical trials for uncomplicated type B aortic dissection

Abstract

The mainstay of management for uncomplicated type B aortic dissection is currently optimal medical therapy, targeting blood pressure and heart rate, along with serial imaging. There is a paucity of data that informs whether early intervention with thoracic endografting in this group of patients will promote aortic remodeling and better long-term outcomes. Investigations to date, including the Investigation of Stent Grafts in Aortic Dissection (INSTEAD), INSTEAD-XL, and Acute Dissection: Stent Graft or Best Medical Therapy (ADSORB) studies, have compared thoracic endovascular aortic repair (TEVAR) with optimal medical therapy in patients with uncomplicated type B aortic dissection but have not shown a benefit for TEVAR conclusively. We discuss three major new randomized trials, which will recruit concurrently in Scandinavia (the Scandinavian trial of uncomplicated aortic dissection therapy [SUNDAY] trial), in the United States (the IMPRoving outcomes in vascular DisEase - aortic dissection [IMPROVE-AD] trial) and the United Kingdom (the Early aortic repair in patients needing endovascular surgery for type B aortic dissection [EARNEST] trial), which promise to provide conclusive, level 1 evidence to decipher whether early TEVAR in this cohort of patients in beneficial.