Thoracic aortic disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

2010 ACCF/AHA Guideline Recommendations: General Medical Treatment and Risk Factor Management (DO NOT EDIT) [1]

Recommendation for Medical Treatment of Patients with Thoracic Aortic Diseases

Class I
"1. Stringent control of hypertension, lipid profile optimization, smoking cessation, and other atherosclerosis risk-reduction measures should be instituted for patients with small aneurysms not requiring surgery, as well as for patients who are not considered to be surgical or stent graft candidates. (Level of Evidence: C) "

2010 ACCF/AHA Guideline Recommendations: Inflammatory Diseases Associated with Thoracic Aortic Disease (DO NOT EDIT) [1]

Recommendations for Takayasu Arteritis and Giant Cell Arteritis

Class I
"1. Initial therapy for active Takayasu arteritis and active giant cell arteritis should be corticosteroids at a high dose (prednisone 40 to 60 mg daily at initiation or its equivalent) to reduce the active inflammatory state. (Level of Evidence: B) "
"2. The success of treatment of patients with Takayasu arteritis and giant cell arteritis should be periodically evaluated to determine disease activity by repeated physical examination and either an erythrocyte sedimentation rate or C-reactive protein level. (Level of Evidence: B)"
"3. Elective revascularization of patients with Takayasu arteritis and giant cell arteritis should be delayed until the acute inflammatory state is treated and quiescent. (Level of Evidence: B)"
Class IIa
"1. It is reasonable to treat patients with Takayasu arteritis receiving corticosteroids with an additionalanti-inflammatory agent if there is evidence of progression of vascular disease, recurrence of constitutional symptoms, or re-elevation of inflammatory marker. (Level of Evidence: C) "

2010 ACCF/AHA Guideline Recommendations: Aortic Arch and Thoracic Aortic Atheroma and Atheroembolic Disease. (DO NOT EDIT) [1]

Recommendations for Aortic Arch and Thoracic Aortic Atheroma and Atheroembolic Disease

Class IIa
"1. Treatment with a statin is a reasonable option for patients with aortic arch atheroma to reduce the risk of stroke. (Level of Evidence: C)"
Class IIb
"1. Oral anticoagulation therapy with warfarin (INR 2.0 to 3.0) or antiplatelet therapy may be considered in stroke patients with aortic arch atheroma 4.0 mm or greater to prevent recurrent stroke. (Level of Evidence: C)"

References

  1. ↑ 1.0 1.1 1.2 Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE; et al. (2010). "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine". Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID 20233780.

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