Grewal Nimrat, Dolmaci Onur, Jansen Evert, Klautz Robert, Driessen Antoine, Lindeman Jan, Poelmann Robert E
Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
Front Cardiovasc Med. 2023 Jan 9;9:1032755. doi: 10.3389/fcvm.2022.1032755. eCollection 2022.
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.
We aim to systematically describe atherosclerotic lesions in TAAD patients.
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.
In the TAAD group thirty-seven percent were overweight (BMI > 25). Diabetes and peripheral arterial disease were not present in any of the patients. Fifty-nine percent of the patients had a history of hypertension. The intima in TAAD patients was significantly thinner as compared to the control group (mean thickness 143 ± 126.5 μm versus 193 ± 132 μm, < 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.
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.
A型主动脉夹层（TAAD）是一种严重的主动脉并发症。患有马凡综合征、二叶式主动脉瓣或胸主动脉瘤的患者发生TAAD的风险增加。这些易患疾病的特征是组织学上内膜层薄且几乎没有动脉粥样硬化。关于A型主动脉夹层患者发生动脉粥样硬化的易感性知之甚少。
我们旨在系统描述TAAD患者的动脉粥样硬化病变。
本研究共纳入51例TAAD患者（平均年龄62.5±10.8岁，49%为女性）和17例对照患者（平均年龄63±5.5岁，53%为女性）。临床评估心血管危险因素。所有切片均用Movat五色染色法和苏木精伊红染色。根据Virmani等人提出的改良AHA分类方案对斑块形态进行分类。
TAAD组中37%的患者超重（BMI>25）。所有患者均无糖尿病和外周动脉疾病。59%的患者有高血压病史。与对照组相比，TAAD患者的内膜明显更薄（平均厚度143±126.5μm对193±132μm，P<0.023）。7例TAAD患者内膜正常，无任何形式的适应性或病理性增厚。23例TAAD患者表现为适应性内膜增厚。14例有内膜黄色瘤，也称为脂纹。少数7例TAAD患者有进展性动脉粥样硬化病变，其中4例表现为病理性内膜增厚，3例患者表现为早期纤维粥样斑块、晚期纤维粥样斑块和薄帽纤维粥样斑块。对照组大多数患者表现为进展性动脉粥样硬化病变：3例病理性内膜增厚，2例早期纤维粥样斑块，6例晚期纤维粥样斑块，1例愈合破裂和2例纤维化钙化斑块。
本研究表明，TAAD患者几乎不表现出任何形式的进展性动脉粥样硬化。大多数TAAD患者表现为非进展性内膜病变，而对照组大多表现为进展性内膜动脉粥样硬化病变。研究结果与年龄、性别或高血压病史无关。
