Real-Time Proximal Extension of Acute Stanford Type B Aortic Dissection During CTA

Acute Stanford type B aortic dissection is generally managed conservatively in hemodynamically stable patients. However, proximal extension to the ascending aorta may occur unpredictably.

An 84-year-old woman presented with isolated chest pain and stable hemodynamics. Initial computed tomography angiography (CTA) suggested acute Stanford type B aortic dissection extending to the aortic bifurcation. During the same CTA examination, delayed-phase imaging obtained 30 seconds later demonstrated new extension into the ascending aorta. Repeat CTA performed 3 minutes after the initial scan showed further proximal progression, confirming acute Stanford type A dissection. Emergent total arch replacement with open stent grafting was performed, and the postoperative course was uneventful.

This case demonstrates that acute Stanford type B aortic dissection may progress to type A within minutes, even without hemodynamic deterioration, highlighting an important limitation of single-phase imaging and a cautionary message when conservative management is considered.