Early aggressive medical treatment associated with selective prophylactic aortic stent-grafting for XXXX .

@entity1 @entity1410 @entity2293
BACKGROUND: Although recent studies suggest that medical treatment is appropriate for @entity1 with @entity1410 (IMH), the outcomes of supportive medical treatment alone have not been satisfactory, and clear guidelines for medical treatment are not yet available. We assessed whether a management protocol of combined early aggressive medical treatment and selective prophylactic aortic stent-grafting would benefit @entity1 with IMH. METHODS: Nineteen @entity1 with IMH were prospectively studied; after initial clinical and radiological evaluation, 13 underwent early aggressive medical therapy (group 1), and 6 underwent early aggressive medical therapy and prophylactic endovascular stent-grafting (group 2). RESULTS: In group 1, one @entity1 with type A IMH died prior to surgical consultation because of @entity2293 ; another @entity1 with type A IMH underwent replacement of the ascending aorta at the 6-month follow-up. The condition of the other 11 @entity1 stabilized during hospitalization and after discharge. The disease spontaneously regressed in 10 @entity1 , and the intramural @entity1410 completely resolved in 5 @entity1 . In group 2, follow-up imaging revealed complete coverage of the penetrating aortic ulcers and regression of the intramural @entity1410 ; endovascular leaks have not yet occurred. CONCLUSIONS: Our protocol may be used as an alternative approach for @entity1 with IMH. After initial clinical and radiological evaluation, the condition of @entity1 without complications can be stabilized with medical treatment; frequent follow-up imaging is required in such cases. Early aggressive medical treatment combined with prophylactic aortic stent-grafting is a safe and effective treatment modality for IMH @entity1 with penetrating aortic ulcers in the descending aorta.
