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The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection
Objective: The incidence of type B aortic dissection (TBAD) is increasing worldwide; however, the underlying pathomechanisms are not conclusively understood. This study explores the geometric architecture of the aortic arch and supra-aortic branches in TBAD patients as opposed to non-TBAD patients....
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10532254/ https://www.ncbi.nlm.nih.gov/pubmed/37762902 http://dx.doi.org/10.3390/jcm12185963 |
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author | Mulorz, Joscha Garcon, Franziska Arnautovic, Amir De Somer, Casper Knapsis, Artis Aubin, Hug Fleissner, Felix Rembe, Julian-Dario Vockel, Malwina Oberhuber, Alexander Lichtenberg, Artur Schelzig, Hubert Wagenhäuser, Markus Udo |
author_facet | Mulorz, Joscha Garcon, Franziska Arnautovic, Amir De Somer, Casper Knapsis, Artis Aubin, Hug Fleissner, Felix Rembe, Julian-Dario Vockel, Malwina Oberhuber, Alexander Lichtenberg, Artur Schelzig, Hubert Wagenhäuser, Markus Udo |
author_sort | Mulorz, Joscha |
collection | PubMed |
description | Objective: The incidence of type B aortic dissection (TBAD) is increasing worldwide; however, the underlying pathomechanisms are not conclusively understood. This study explores the geometric architecture of the aortic arch and supra-aortic branches in TBAD patients as opposed to non-TBAD patients. Methods: Patient characteristics were retrieved from archived medical records. Computer-assisted tomography (CAT) scans of patients with TBAD and carotid stenosis (CS) from two high-volume centers were analyzed. Various aortic arch parameters and take-off angles of the supra-aortic branches of TBAD patients were measured following centerline normalization in comparison CS patients. A compression index (C-index) was calculated from the para-sagittal, and a torsion index (T-index) was calculated from the para-coronal take-off angles of the supra-aortic branches to analyze aortic arch tortuosity. Results: A total of 199 CAT scans were analyzed, namely, 85 in the TBAD group and 114 in the CS group. The average age was 61.5 ± 13.1 years among the TBAD patients and 71 ± 9.3 years among the CS patients. We found a significantly higher proportion of type III aortic arch configurations in TBAD patients compared with CS patients. Further, the aortic arch angle was steeper in the TBAD group. In the para-sagittal plane, the left subclavian artery (LSA) take-off angle was less steep in TBAD patients. In the para-coronal plane, the left carotid artery (LCA) had a less steep take-off angle, while the LSA had a more obtuse take-off angle in the TBAD group when compared with the CS group. In addition, the inter-vessel distance was increased in TBAD patients. Finally, the T-index was increased, suggesting a significant torsion resulting from the deviating take-off angles of the supra-aortic branches supplying the left half of the body as opposed to the innominate artery (IA) in TBAD patients. Conclusions: Our results suggest several aortic arch-specific geometric configurations in patients suffering from TBAD that significantly differ from those in CS patients. Further functional studies are needed to verify the pathogenetic relevance of our results and their disease-specific causality. Although our data are not mechanistically explorative, they may serve as a basis for identifying future patients with aortic arch morphology at higher risk for TBAD development and who may benefit from more stringent adjustment of risk factors as a primary prevention concept. |
format | Online Article Text |
id | pubmed-10532254 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-105322542023-09-28 The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection Mulorz, Joscha Garcon, Franziska Arnautovic, Amir De Somer, Casper Knapsis, Artis Aubin, Hug Fleissner, Felix Rembe, Julian-Dario Vockel, Malwina Oberhuber, Alexander Lichtenberg, Artur Schelzig, Hubert Wagenhäuser, Markus Udo J Clin Med Article Objective: The incidence of type B aortic dissection (TBAD) is increasing worldwide; however, the underlying pathomechanisms are not conclusively understood. This study explores the geometric architecture of the aortic arch and supra-aortic branches in TBAD patients as opposed to non-TBAD patients. Methods: Patient characteristics were retrieved from archived medical records. Computer-assisted tomography (CAT) scans of patients with TBAD and carotid stenosis (CS) from two high-volume centers were analyzed. Various aortic arch parameters and take-off angles of the supra-aortic branches of TBAD patients were measured following centerline normalization in comparison CS patients. A compression index (C-index) was calculated from the para-sagittal, and a torsion index (T-index) was calculated from the para-coronal take-off angles of the supra-aortic branches to analyze aortic arch tortuosity. Results: A total of 199 CAT scans were analyzed, namely, 85 in the TBAD group and 114 in the CS group. The average age was 61.5 ± 13.1 years among the TBAD patients and 71 ± 9.3 years among the CS patients. We found a significantly higher proportion of type III aortic arch configurations in TBAD patients compared with CS patients. Further, the aortic arch angle was steeper in the TBAD group. In the para-sagittal plane, the left subclavian artery (LSA) take-off angle was less steep in TBAD patients. In the para-coronal plane, the left carotid artery (LCA) had a less steep take-off angle, while the LSA had a more obtuse take-off angle in the TBAD group when compared with the CS group. In addition, the inter-vessel distance was increased in TBAD patients. Finally, the T-index was increased, suggesting a significant torsion resulting from the deviating take-off angles of the supra-aortic branches supplying the left half of the body as opposed to the innominate artery (IA) in TBAD patients. Conclusions: Our results suggest several aortic arch-specific geometric configurations in patients suffering from TBAD that significantly differ from those in CS patients. Further functional studies are needed to verify the pathogenetic relevance of our results and their disease-specific causality. Although our data are not mechanistically explorative, they may serve as a basis for identifying future patients with aortic arch morphology at higher risk for TBAD development and who may benefit from more stringent adjustment of risk factors as a primary prevention concept. MDPI 2023-09-14 /pmc/articles/PMC10532254/ /pubmed/37762902 http://dx.doi.org/10.3390/jcm12185963 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Mulorz, Joscha Garcon, Franziska Arnautovic, Amir De Somer, Casper Knapsis, Artis Aubin, Hug Fleissner, Felix Rembe, Julian-Dario Vockel, Malwina Oberhuber, Alexander Lichtenberg, Artur Schelzig, Hubert Wagenhäuser, Markus Udo The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection |
title | The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection |
title_full | The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection |
title_fullStr | The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection |
title_full_unstemmed | The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection |
title_short | The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection |
title_sort | role of spatial aortic arch architecture in type b aortic dissection |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10532254/ https://www.ncbi.nlm.nih.gov/pubmed/37762902 http://dx.doi.org/10.3390/jcm12185963 |
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