Sage Journals: Discover world-class research

Abstract

The arterial properties and pathogenesis of aortic dissection remain obscure. To examine the arterial properties of patients with aortic dissection, the authors studied the ultrasonographic characteristics of the carotid artery in patients with an aortic dissection (AD, n=86), and compared these findings with data of patients suffering from arteriosclerosis obliterans (ASO, n=151), coronary artery disease (CAD, n=163), and with healthy controls (HC, n=77). Atherosclerotic intimal changes, such as intima-media thickness (IMT) and plaque formation, were milder in AD than in ASO or CAD (IMT: 0.83 ±0.16 vs 0.93 ±0.20/0.86 ±0.17 mm, p<0.05; plaque number: 0.6 ±1.1 vs 2.7 ±2.4/2.5 ±2.1, p<0.05). Luminal diameter in AD, ASO, and CAD was significantly higher than in HC. The luminal distensibility in AD was decreased compared with HC but was the same as in ASO and CAD. Intra-AD group analysis showed that in patients with an intramural hematoma (IMH) or a dissection with a thrombosed false lumen (TLF) the IMT was higher than in patients with a classic dissection. In addition, plaque formation was more severe in AD patients with a coexisting abdominal aortic aneurysm (AAA). Reduced distensibility without severe intimal disease was found in AD. These findings suggest that patients with AD may have several arterial alterations, including structural abnormalities. Patients with IMH, TFL, or coexisting AAA may differ from patients who have a classic type of dissection or who do not have AAA, in terms of arterial characteristics including intimal disease and wall elastic property, and the initiating cause of the dissection. Introduction Owing to the progress that has been made in various imaging modalities, the improvement in the accuracy of diagnosing an aortic dissection has resulted in an increase in the detection rate of the various subtypes of classic dissection, such as those associated with an intramural hematoma (IMH), hemorrhage, or a penetrating atherosclerotic ulcer.^1,2 However, the etiology and pathogenesis of these catastrophic aortic disorders remain obscure. From the clinical perspective, it has Angiology 57:478–486, 2006 From the Department of Medicine II, Iwate Medical University, Morioka, Japan Correspondence: DOI: 10.1177/0003319706290625 Copyright © 2006 Sage Publications

Get full access to this article

View all access options for this article.

References

Hussain S , Glover JL , Bree R : Penetrating atherosclerotic ulcers of the descending aorta thoracic aorta. Evaluation with CT and distinction from aortic dis-section. Radiology 183:759-765, 1992.

Nienaber CA , Kodolitsch Y , Petersen B , et al: Intramural hemorrhage of thoracic aorta: Diagnostic and therapeutic implications. Circulation 92:1465-1472, 1995.

O’Gara PT , Desanctis RW : Acute aortic dissection and its variants: Toward a common diagnostic and therapeutic approach. Circulation 92:1376-1378, 1995.

Nakashima Y , Shiokawa Y , Sueishi K : Alterations of elastic architecture in human aortic dissecting aneurysm. Lab Invest 62:751-760, 1990.

Burke GL , Evans GW , Riley WA , et al: Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. The atherosclerosis risk in communities (ARIC) study. Stroke 26:386-391, 1995.

Allan PL , Mowbray PI , Lee AJ , et al: Relationship between carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease. The Edinburgh artery study. Stroke 28:348-353, 1997.

Mannami T , Konishi M , Baba S , et al: Prevalence of asymptomatic carotid atherosclerotic lesions detected by high-resolution ultrasonography and its relation to cardiovascular risk factors in the general population of a Japanese city. The Suita study. Stroke 28:518-525, 1997.

Hayashi K , Handa H , Nagasawa S , et al: Stiffness and elastic behavior of human intracranial and extracranial arteries. J Biomech 13:175-184, 1980.

Kawasaki T , Sasayama S , Yagi S , et al: Noninvasive assessment of the age related changes in stiffness of major branches of the human arteries. Cardiovasc Res 21:678-687, 1987.

10.

Roberts WC : Aortic dissection: Anatomy, consequences, and causes. Am Heart J 101:195-214, 1981.

11.

Riley WA , Barnes R , Evans GW , et al: Ultrasonic measurement of the elastic modulus of the common carotid artery: The atherosclerosis risk in communities (ARIC) study. Stroke 23:952-956, 1992.

12.

Laurent S : Arterial wall hypertrophy and stiffness in essential hypertensive patients. Hypertension 26:355-362, 1995.

13.

Polak JF , Kronmal RA , Tell GS , et al: Compensatory increase in common carotid artery diameter: Relation to blood pressure and artery intima-media thickness in older adults. Stroke 27:2012-2015, 1996.

14.

Steinke W , Els T , Hennerici M : Compensatory carotid artery dilatation in early atherosclerosis. Circulation 89:2578-2581, 1994.

15.

Bonithon-Kopp C , Touboul PJ , Berr C , et al: Factors of carotid arterial enlargement in a population aged 59 to 71 years: The EVA study. Stroke 27:654-660, 1996.

16.

Glagov S , Weisenberg E , Zarins CK , et al: Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316:1371-1375, 1987.

17.

Salgado ED : Medial aortic lesion in rats with metacorticoid hypertension. Hypertension 58:305-327, 1970.

18.

Nakashima Y , Sueishi K : Alteration of elastic architecture in the lathyritic rat aorta implies the pathogenesis of aortic dissecting aneurysm. Am J Pathol 140:959-969, 1992.

19.

Hamano K , Kuga T , Takahashi M , et al: The lack of type III collagen in a patients with aneurysms and an aortic dissection. J Vasc Surg 28:1104-1106, 1998.

20.

Makita S , Nakamura M , Ohira A , et al: Abnormal peripheral vasodilatory reserve without endothelial dys-function in a patient with aortic dissection. Int J Angiol 9:57-61, 2000.

21.

Robbins RC , McManus RP , Mitchell RS , et al: Management of patients with intramural hematoma of the thoracic aorta. Circulation 88:II1-II10, 1993.

22.

Tissen IM , Roach MR : Factors in initiation and propagation of the aortic dissections in human autopsy cases. J Biomech Eng 115:123-125, 1993.

23.

Johnson G , Avery A , McDougall EG , et al: Aneurysms of the abdominal aorta. Arch Surg 120:1138-1140, 1985.

24.

Makita S , Ohira A , Tachieda R , et al: Dilation and reduced distensibility of carotid artery in patients with abdominal aortic aneurysms. Am Heart J 140:297-302, 2000.

25.

Van Bortel LM , Kool MJ , Boudier HA , et al: Effects of antihypertensive agents on local arterial distensibility and compliance. Hypertension 26:531-534, 1995.

26.

Girerd X , Giannattasio C , Mourin C , et al: Regression of radial artery wall hypertrophy and improvement of carotid artery compliance after long-term antihypertensive treatment in elderly patients. J Am Coll Cardiol 31:1064-1073, 1998.

Increased Carotid Artery Stiffness Without Atherosclerotic Change in Patients With Aortic Dissection

Abstract

Get full access to this article

References