Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, UK.
Ann Cardiothorac Surg. 2014 May;3(3):314-8. doi: 10.3978/j.issn.2225-319X.2014.05.16.
While the medical management of uncomplicated type B aortic dissection has good outcomes in the short term, the longer term mortality can be in the region of 50% at 5 years. Up to 40% of the survivors can have significant dilatation of the false lumen with the risk of aneurysm formation and death due to rupture. The results of the randomized controlled trials ADSORB and INSTEAD-XL have shown that beneficial aortic remodelling occurs after endoluminal stent graft placement, but these trials were underpowered to show any effect on survival. Static computed tomography (CT) angiography imaging methods have been used to try to identify high risk patients using parameters such as diameter, the position and size of the entry tear, and the amount of false lumen thrombus, but these so far are not able to clinically risk stratify individual patients. In this manuscript, we present our initial experience with new MR imaging methods. These have allowed us to develop a greater understanding of aortic dissection by providing information regarding the underlying hemodynamic and biomechanics of the dissection, as well as more accurate assessment of important clinical imaging endpoints, such as false lumen thrombosis.
虽然复杂型 B 型主动脉夹层的医学治疗在短期内有良好的效果，但 5 年内的长期死亡率可能高达 50%。多达 40%的幸存者可能会出现假腔的显著扩张，从而导致动脉瘤形成和破裂导致死亡的风险。ADSORB 和 INSTEAD-XL 这两项随机对照试验的结果表明，血管内支架移植物置入后可出现有益的主动脉重塑，但这些试验的效力不足以显示对生存率有任何影响。静态计算机断层（CT）血管造影成像方法已被用于尝试使用直径、入口撕裂的位置和大小以及假腔血栓量等参数来识别高危患者，但迄今为止，这些方法尚无法对个体患者进行临床风险分层。在本文中，我们介绍了我们在新的磁共振成像方法方面的初步经验。这些方法使我们通过提供有关夹层的潜在血流动力学和生物力学的信息，以及对重要的临床成像终点（如假腔血栓形成）进行更准确的评估，从而对主动脉夹层有了更深入的了解。
