A New Clinically Driven Classification for Acute Aortic Dissection

Abstract

Objectives: To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The proposed classification was evaluated retrospectively in a large population. Materials and Methods: We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes. Results: According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (p < 0.001). Conclusion: The new AAD classification was feasible, and type C was easily identified ("non-A, non-B"). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments.

Computed Tomography Angiography Assessment of Acute Aortic Syndromes: Classification, Differentiating Imaging Features, and Imaging Interpretation Pitfalls

“…[17][18][19][20] The term ''non-A non-B'' or ''type C'' have been used to describe this subset of dissections, or Type B with arch involvement, or simply arch dissection. [18][19][20][21] In contrast, the SVS-STS classification : all dissections involving the ascending aorta (up to the origin of the right brachiocephalic artery) are type A dissections. Dissections that do not involve the ascending aorta are type B, the majority of which involve the descending thoracic aorta distal to the left subclavian artery.…”

“…[17][18][19][20] The term ''non-A non-B'' or ''type C'' have been used to describe this subset of dissections, or Type B with arch involvement, or simply arch dissection. [18][19][20][21] In contrast, the SVS-STS classification describes arch ADs because it divides the thoracoabdominal aorta into zones utilized in thoracic endovascular aortic repair (TEVAR) reporting standards (Figure 3). 15,22 This nomenclature divides the aorta into zones (0-11), specifying that type A dissections originate in zone 0 (ascending aorta) and type B dissections originate in zone 1 or beyond.…”

Short Term Prognosis of Renal Artery Stenosis Secondary to Acute Type B Aortic Dissection With TEVAR

“…In this study, we defined RAS as a decrease in the effective diameter of one or both renal arteries of more than 60% (6) (Figure 1). Renal artery stenosis is mainly divided into flow limiting dynamic hemodynamic compression (B1), non-flow limiting static section (B2), and flow limiting static section (B3) (11). The left of Figure 1 is B1, and the right of Figure 1 belongs to B2 or B3.…”

Thoracic Endovascular Aortic Repair for Retrograde Type A Aortic Intramural Hematoma

“…The inclusion criteria were (a) patients with TAIMH, (b) patients with PAU or entry tear in descending aorta, and (c) patients treated by TEVAR or one-stop hybrid operation (TEVAR with aortic arch branch vessel bypass). The exclusion criteria were (a) patients with PAU or AD in ascending aorta and aortic arch, (b) patients with TAIMH and ulcer-like projection (ULP) in descending aorta, (c) patients treated by surgery, (d) patients with IMH that involves the arch without extension to the ascending aorta ( 13 ), and (e) patients with incomplete data including imaging and follow-up data.…”