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Updated: Aug 12, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Are acute type A aortic dissections atherosclerotic?
Nimrat Grewal1,2,3, Onur Dolmaci1,2, Evert Jansen1
1Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.
Background:
Type A aortic dissections (TAAD) are devastating aortic complications. Patients with Marfan syndrome, a bicuspid aortic valve or a thoracic aortic aneurysm have an increased risk to develop a TAAD. These predisposing conditions are characterized by a histologically thin intimal layer and hardly any atherosclerosis. Little is known about the susceptibility for atherosclerosis in patients with a type A aortic dissection.
Objective:
We aim to systematically describe atherosclerotic lesions in TAAD patients.
Materials And Methods:
A total of 51 patients with a TAAD (mean age 62.5 ± 10.8 years, 49% females) and 17 control patients (mean age 63 ± 5.5 years, 53% females) were included in this study. Cardiovascular risk factors were assessed clinically. All sections were stained with Movat pentachrome and hematoxylin eosin. Plaque morphology was classified according to the modified AHA classification scheme proposed by Virmani et al.
Results:
In the TAAD group thirty-seven percent were overweight (BMI > 25). Diabetes and peripheral arterial disease were not present in any of the patients. Fifty-nine percent of the patients had a history of hypertension. The intima in TAAD patients was significantly thinner as compared to the control group (mean thickness 143 ± 126.5 μm versus 193 ± 132 μm, p < 0.023). Seven TAAD patients had a normal intima without any form of adaptive or pathological thickening. Twenty-three TAAD patients demonstrated adaptive intimal thickening. Fourteen had an intimal xanthoma, also known as fatty streaks. A minority of 7 TAAD patients had progressive atherosclerotic lesions, 4 of which demonstrated pathological intimal thickening, 3 patients showed early fibroatheroma, late fibroatheroma and thin cap fibroatheroma. In the control group the majority of the patients exhibited progressive atherosclerotic lesions: three pathologic intimal thickening, two early fibroatheroma, six late fibroatheroma, one healed rupture and two fibrotic calcified plaque.
Discussion:
This study shows that TAAD patients hardly exhibit any form of progressive atherosclerosis. The majority of TAAD patients showcase non-progressive intimal lesions, whereas the control group mostly demonstrated progressive intimal atherosclerotic lesions. Findings are independent of age, sex, or the presence of (a history of) hypertension.
Insights
Type A aortic dissection (TAAD) patients exhibit minimal progressive atherosclerosis, showing non-progressive intimal lesions unlike controls. This finding is independent of common cardiovascular risk factors.
Area of Science:
- Cardiovascular Research
- Atherosclerosis Studies
- Aortic Disease Research
Background:
- Type A aortic dissection (TAAD) is a severe aortic complication.
- Predisposing conditions like Marfan syndrome, bicuspid aortic valve, or thoracic aortic aneurysm are linked to TAAD.
- These conditions feature a thin intimal layer and minimal atherosclerosis, with limited knowledge on TAAD patients' atherosclerosis susceptibility.
Purpose of the Study:
- To systematically characterize atherosclerotic lesions in patients diagnosed with Type A aortic dissection (TAAD).
Main Methods:
- Included 51 TAAD patients and 17 controls, assessing cardiovascular risk factors.
- Aortic tissue sections were stained with Movat pentachrome and hematoxylin eosin.
- Plaque morphology was classified using the modified AHA classification by Virmani et al.
Main Results:
- TAAD patients had significantly thinner intima compared to controls (143 ± 126.5 μm vs. 193 ± 132 μm).
- The majority of TAAD patients displayed non-progressive intimal lesions (e.g., intimal xanthoma), while controls showed progressive lesions.
- Hypertension was present in 59% of TAAD patients; diabetes and peripheral arterial disease were absent.
Conclusions:
- TAAD patients demonstrate a notable lack of progressive atherosclerosis.
- Non-progressive intimal lesions are characteristic of TAAD patients, contrasting with the progressive lesions found in controls.
- These observations remain consistent regardless of age, sex, or hypertension history.
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