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Association Between Aortic Calcification and Primary Intimal Tear in Type B Aortic Dissection
Weihang Lu1, Long Cao2, Shaoliang Luan3
1Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, PR China.
Annals of Vascular Surgery
|November 9, 2025
Summary
Calcifications near aortic intimal tears in acute type B aortic dissection (TBAD) are common. These calcifications, along with microcalcification activity and altered blood flow, may contribute to the formation of primary intimal tears (PITs).
Area of Science:
- Cardiovascular Research
- Medical Imaging
- Biomechanical Engineering
Background:
- Acute type B aortic dissection (TBAD) is a serious condition.
- Understanding the factors contributing to primary intimal tear (PIT) formation is crucial for improving TBAD management.
- Aortic calcification distribution and its role in PIT formation require further investigation.
Purpose of the Study:
- To determine the association between aortic calcification distribution and PITs in acute TBAD patients.
- To evaluate the role of calcifications in PIT formation using computational fluid dynamics (CFD).
Main Methods:
- Retrospective analysis of two cohorts (n=260) of acute TBAD patients.
- Cross-sectional analysis of CT-visible calcification distribution at PIT sites.
- 18F-NaF PET/CT to detect CT-invisible microcalcifications near PITs.
- CFD simulations to analyze wall shear stress (WSS) and oscillatory shear index (OSI) around calcifications.
Main Results:
- Calcifications adjacent to PITs were observed in 18.5% of patients, primarily along dissected intimal flaps.
- Exploratory PET/CT revealed focal microcalcification activity near PIT regions.
- CFD simulations indicated hemodynamic abnormalities (low WSS, high OSI) near calcifications overlapping the PIT.
Conclusions:
- A significant spatial association exists between calcifications and PITs in aortic dissection.
- Microcalcification activity and local hemodynamic disturbances may co-localize with PITs.
- Findings suggest calcifications may play a role in PIT formation, requiring further validation.
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