Are acute type A aortic dissections atherosclerotic?

Frontiers in Cardiovascular Medicine, vol. 9, pp. 1032755

Abstract

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: < 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.

Authors 7

1. Nimrat Grewal corresponding Aachen Department of Anatomy and Embryology Department of Cardiothoracic Surgery

   Leiden University Medical Center · Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands

   Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands

2. Onur Baris Dolmaci Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center · Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands

3. Evert K. Jansen

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands

4. Robert J.M. Klautz Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center · Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands

   Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands

5. Antoine H.G. Driessen

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands

6. Jan H.N. Lindeman Aachen Department of Vascular Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, Leiden, Netherlands

7. Robert E. Poelmann Aachen Department of Cardiology, Leiden University Medical Center Institute of Biology, Animal Sciences and Health

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands

   Institute of Biology, Animal Sciences and Health, Leiden University, Leiden, Netherlands