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Need for and update on clinical trials for uncomplicated type B aortic dissection
Michael Greshan Rasiah1, Mohamed Ahmed Abdelhalim1, Bijan Modarai1
1Academic Department of Vascular Surgery, South Bank Section, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Research Excellence, St Thomas' Hospital, London, UK.
Jvs-Vascular Insights
|December 30, 2024
Summary
Optimal medical therapy is standard for uncomplicated type B aortic dissection. New trials will determine if early thoracic endovascular aortic repair (TEVAR) improves long-term outcomes and aortic remodeling.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Medical Imaging
Background:
- Uncomplicated type B aortic dissection management relies on optimal medical therapy (OMT) and serial imaging.
- Evidence is lacking on whether early thoracic endovascular aortic repair (TEVAR) benefits aortic remodeling and long-term outcomes in these patients.
Purpose of the Study:
- To evaluate the effectiveness of early TEVAR compared to OMT for uncomplicated type B aortic dissection.
- To provide level 1 evidence on the long-term benefits of early intervention in this patient cohort.
Main Methods:
- Discussion of three concurrent, large-scale randomized trials: SUNDAY (Scandinavia), IMPROVE-AD (USA), and EARNEST (UK).
- These trials aim to provide conclusive evidence by comparing early TEVAR with OMT.
Main Results:
- Previous studies (INSTEAD, INSTEAD-XL, ADSORB) have not conclusively demonstrated a benefit for TEVAR over OMT.
- Results from the new trials are pending but are expected to offer definitive insights.
Conclusions:
- The ongoing SUNDAY, IMPROVE-AD, and EARNEST trials are poised to resolve the debate on early TEVAR for uncomplicated type B aortic dissection.
- Conclusive, level 1 evidence is anticipated to guide future clinical management strategies.
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