Retearing of type B blind cystic aortic dissection: computational fluid dynamics analysis

Aortic dissection (AD) is a serious life-threatening vascular disease. However, research on type B blind cystic AD is still insufficient. This type of AD involves only one proximal intimal tear, and the distal end of the aortic false lumen (FL) is a blind sac. The purpose of this study was to explore the haemodynamic indicators of retearing and high-risk areas for FL rupture in type B blind cystic AD patients. This study included 4 cases of type B blind cystic AD rupture death, which revealed the pathological characteristics of the aorta. In addition, imaging data from one deceased and four patients with type B AD (TBAD) with multiple intimal tears were collected, and two groups of models (n = 10) were constructed. The pressure, velocity, time-averaged wall shear stress (TAWSS), and relative residence time (RRT) were compared to interpret our autopsy results. In type B blind cystic AD patients, the FL is characterized by high pressure, a low TAWSS, and high RRT. There was a relatively high TAWSS in the FL adjacent to the proximal intimal tear; at the same time, both the blood flow velocity and the pressure difference in the true lumen (TL) significantly changed. In addition, the greater the curvature of the aorta is, the more drastic the change in the luminal pressure difference. In type B blind cystic AD, high pressure may be the main reason for FL rupture, and the FL adjacent to the proximal intimal tear may be a high-risk rupture area. In addition, alterations in blood flow velocity and differential pressure may cause distal intimal retears. Tortuosity is an important indicator for studying pressure changes.