The INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) Trial

Abstract

In the present issue of Circulation , Nienaber et al1 report the results of a randomized comparison of strategies for type B dissection: the INvestigation of STEnt grafts in Aortic Dissection (INSTEAD) trial. This trial represents the first prospective randomized study of elective stent graft placement in survivors of uncomplicated chronic type B aortic dissection. The results have been eagerly anticipated by clinicians, particularly in light of recent analyses of the benefits of endovascular repair for abdominal aortic aneurysms2,3 and thoracic endovascular aneurysm repair (TEVAR) for the treatment of degenerative thoracic aneurysms.4–6 The authors are to be commended on providing Level 1 evidence to assist us in the management of chronic aortic dissection. The INSTEAD trial demonstrates that thoracic stent graft (TEVAR) placement failed to improve the rates of 2-year survival and adverse events when compared with optimal medical therapy (OMT). Although considerable attention to detail was paid by the authors in the design of this trial,7 several limitations exist that may preclude using these results to determine the final role of stent grafts in the management of chronic aortic dissection. Article see …