Challenging Current Conservative Management of Uncomplicated Acute Type B Aortic Dissections

Despite weak evidence, current treatment guidelines for uncomplicated acute type B aortic dissection (uATBAD) consistently recommend intensive and rapid lowering of systolic blood pressure and heart rate.

The case of a 62 year old man with uATBAD, who was treated according to guidelines, is presented. Owing to an unknown chronic occlusion of the left carotid artery combined with intensive hypotensive treatment, the patient developed a cerebral infarct.

The case illustrates a severe complication of the widely accepted management of uATBAD. This case, along with scrutiny of guidelines and the evidence behind these guidelines, provoke questions regarding the rationale of current conservative management, and whether it should be challenged with alternative strategies employing a more cautious blood pressure regimen. It also highlights the importance of evaluating the vessels of the supra-aortic trunk when determining the extent of the dissection.