The Impact of Intimal Tear Location and Partial False Lumen Thrombosis in Acute Type B Aortic Dissection

Relationship between serum cortisol level and degree of false lumen thrombosis in patients with uncomplicated type B aortic dissection

“…Thrombus formation is a complex biological process involving many chemical and biological species, transport phenomena, and kinetic processes. Some studies have reported a strong relationship of the thrombus state of false lumen with the late events of AD 4 – 6 . Moreover, patients with type B aortic dissection (TBAD) with partial false lumen thrombosis have been found to have an increased late mortality risk 7 .…”

Commentary: Location, location, location

“…It can be speculated that the larger tears located in the proximal descending thoracic aorta lead to increased pressures in the false channel-especially when there are no outflow fenestrations. 8 It remains unknown how the increased pressures affect the integrity of the dissected aortic wall, leading to aneurysmal degeneration. Accepting that this report is limited by its small cohort size, it still corroborates others' work analyzing risk factors for late complications after acute aortic dissection.…”

Editorial on the article entitled “the impact of intimal tear location and partial false lumen thrombosis in acute type b aortic dissection”

“…The experimental study analyzing the most likely clinical scenarios in acute type B aortic dissection (ATBAD) with regards to the false lumen (FL) thrombus status by Girish et al (1) provides valuable information and new insights regarding the prognostic implications and mechanisms of partial FL thrombus formation. While medical therapy remains the treatment of choice for non-complicated ATBAD with early survival rates reaching 90%, surgery and increasingly, thoracic endovascular aortic repair (TEVAR) options remain reserved for urgent life threatening complications such as aortic rupture, enlarging aneurysms, and or evolving organ malperfusion (2,3).…”

“…However, given the significantly faster growth rate in the sac (n=3) versus non-sac type FL (n=17) and the significantly fewer sac type FL patients in their study cohort, the conclusions drawn from this study cannot be applied to the broader type B aortic dissection population. Using extracted porcine aortic segments (n=25), Girish et al (1) experimentally recreated 5 subtypes of ATBAD models depending on the number and location of intimal tears and thrombosis status of the FL (simulated patent versus partial thrombosis). The simulated models of partially thrombosed FL showed divergent hemodynamic profiles depending on the intimal opening location and FL flow direction.…”

“…Indeed, in a previous study (16) which corroborated the hemodynamic implications of this study along with an earlier report by Kaji et al (17), we showed that acute spontaneous retrograde type A dissection was associated with a more favorable prognosis than aortic dissection with antegrade flow. In this context, the insights provided by Girish et al (1) and the experimental design that was used may serve as a solid foundation for continuing related research that will ultimately help in expanding our understanding and efforts to treat this difficult disease.…”