{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:40:33Z","timestamp":1785865233101,"version":"3.56.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Due to its favorable outcome regarding late morbidity and mortality, thoracic endovascular repair (TEVAR) is becoming more popular for uncomplicated type B aortic dissection (TBAD). This study aimed to compare preemptive endovascular treatment and optimal medical treatment (OMT) and OMT alone in patients presenting uncomplicated TBAD with predictors of aortic progression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective multicenter study<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed patients with uncomplicated TBAD and risk factors of progression in two French academic centers. Aortic events [defined as aortic-related (re)intervention or aortic-related death after initial hospitalization], postoperative complications, non-aortic events, and radiologic aortic progression and remodeling were recorded and analyzed. Analysis was performed on an intention-to-treat basis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2011 and 2021, preemptive endovascular procedures at the acute and early subacute phase (&amp;lt;30 days) were performed on 24 patients (group 1) and OMT alone on 26 patients (group 2). With a mean follow-up of 38.08\u2009\u00b1\u200924.53 months, aortic events occurred in 20.83% of patients from group 1 and 61.54% of patients from group 2 (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u2009.001). No patient presented aortic-related death during follow-up. There were no differences in postoperative events (<jats:italic>p<\/jats:italic>\u2009=\u20091.00) and non-aortic events (<jats:italic>p<\/jats:italic>\u2009=\u20091.00). OMT patients had significantly more aneurysmal progression of the thoracic aorta (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u2009.001) and maximal aortic diameter (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u2009.001). Aortic remodeling was found in 91.67% of patients in group 1 and 42.31% of patients in group 2 (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u2009.001). A subgroup analysis of patients in group 1 showed that patients treated with preemptive TEVAR and STABILISE had reduced maximum aortic diameters at the 1-year (<jats:italic>p<\/jats:italic>\u2009=\u2009.010) and last follow-up (<jats:italic>p<\/jats:italic>\u2009=\u2009.030) compared to those in patients treated with preemptive TEVAR alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Preemptive treatment of uncomplicated TBAD with risk factors of progression reduces the risk of long-term aortic events. Over 60% of medically treated patients will require intervention during follow-up, with no benefit in terms of postoperative events. Even after surgical treatment, patients in the OMT group had significantly more aneurysmal progression, along with poorer aortic remodeling.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1362576","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T04:57:35Z","timestamp":1714107455000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Preemptive treatment in the acute and early subacute phase of uncomplicated type B aortic dissections with poor prognosis factors"],"prefix":"10.3389","volume":"11","author":[{"given":"Charlotte","family":"Sachs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabien","family":"Vecchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Corniquet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Bartoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Antoine","family":"Barral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"De Masi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virgile","family":"Omnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Piquet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marc","family":"Alsac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marine","family":"Gaudry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1161\/01.CIR.0000087009.16755.E4","article-title":"Aortic dissection: new frontiers in diagnosis and management: part I: from etiology to diagnostic strategies","volume":"108","author":"Nienaber","year":"2003","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1378\/chest.117.5.1271","article-title":"Epidemiology and clinicopathology of aortic dissection","volume":"117","author":"M\u00e9sz\u00e1ros","year":"2000","journal-title":"Chest"},{"key":"B3","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1093\/eurheartj\/ehx319","article-title":"Acute aortic syndromes: diagnosis and management, an update","volume":"39","author":"Bossone","year":"2018","journal-title":"Eur Heart J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1161\/CIRCINTERVENTIONS.113.000463","article-title":"Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial","volume":"6","author":"Nienaber","year":"2013","journal-title":"Circ: Cardiovasc Interv"},{"key":"B5","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.ccl.2017.03.007","article-title":"Type B aortic dissections","volume":"35","author":"Alfson","year":"2017","journal-title":"Cardiol Clin"},{"key":"B6","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.ejvs.2016.06.005","article-title":"Editor\u2019s choice \u2013 management of descending thoracic aorta diseases","volume":"53","author":"Riambau","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/j.jvs.2019.11.013","article-title":"Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections","volume":"71","author":"Lombardi","year":"2020","journal-title":"J Vasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/j.ejvs.2014.05.012","article-title":"Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial","volume":"48","author":"Brunkwall","year":"2014","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. 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