Purpose To determine whether baseline clinical characteristics and cardiac MRI parameters predict major adverse cardiac events (MACEs) in participants with angiographically confirmed spontaneous coronary artery dissection (SCAD). Materials and Methods This prospective single-center study included participants with SCAD who were angiographically diagnosed between March 2018 and November 2023. Cardiac MRI was performed after a median of 4 days (IQR, 1.5-7) from symptom onset. SCAD types were classified according to the Yip-Saw system. Follow-up evaluation was performed at a median of 5.5 months after discharge, and MACEs were recorded. The primary outcome was the occurrence of MACEs. Secondary analyses included extent of late gadolinium enhancement (LGE). Statistical analysis included binary logistic and Cox proportional hazards regression. Results Overall, 59 participants (mean age, 49 years ± 10; 40 female participants [68%]) were included. ST-elevation myocardial infarction at presentation was diagnosed in 24 of 59 (41%). Angiographically, 41 of 59 (69.5%) were SCAD type 2. Baseline cardiac MRI demonstrated acute injury in 48 of 59 (81%) and LGE in 54 of 59 (93%), typically moderate (median, three segments [IQR, two to five]). In the adjusted model, ST-elevation myocardial infarction manifestation independently predicted greater LGE extent (P = .02; odds ratio, 7.00; 95% CI: 2.00, 24.00). After multivariable adjustment, SCAD type 1 was significantly associated with MACEs (P = .002; hazard ratio, 10.00; 95% CI: 2.00, 23.00), as was transmural LGE (P = .006; hazard ratio, 1.50; 95% CI: 1.10, 2.10). A threshold of greater than or equal to four LGE segments identified a critical risk zone. Conclusion In SCAD, SCAD type 1 and involvement of more than three transmural LGE segments at acute cardiac MRI independently predicted MACEs. Keywords: MR Perfusion, Cardiac, Arteries, Cardiomyopathies, Ischemia/Infarction Supplemental material is available for this article. © RSNA, 2026.

Animal models are essential for translating diagnostic and therapeutic strategies into clinical practice and offer valuable insights into the pathophysiology of diseases such as aortic dissection. This study presents a novel acute in vivo large animal model of Stanford type A aortic dissection, combining open surgical access with endovascular techniques to leverage the advantages of both. The model aims to reproducibly simulate acute dissections in swine, providing a standardized platform for evaluating diagnostics, disease mechanisms, and treatment strategies. Six pigs underwent a standardized protocol to induce aortic dissection. Arterial pressure was monitored via femoral and carotid catheterization. A conventional sternotomy was performed, followed by tangential cross-clamping of the ascending aorta and a controlled incision proximal to the brachiocephalic trunk. The intima and the media were separated using a guidewire and catheter-based technique to create a false lumen. A re-entry tear was also established to allow for controlled intraluminal access. Animals were monitored for 12 h post-intervention, with serial blood sampling. At the end of the experiment, the animals were euthanized and the aortas harvested for macroscopic and histological analysis. In all 6 animals, the placement of arterial catheters in femoral and carotid arteries, as well as the sternotomy, was established without any complications. The dissection model was successfully created in 5 out of 6 animals by clinical signs such as adventitial hematoma, macroscopic wall separation and/or decreased femoral blood pressure. One animal experienced complete aortic perforation. Five animals completed the full observation period of 12 h. A standardized, reproducible, and robust large animal model of acute Stanford type A aortic dissection using a hybrid approach was developed. This model closely simulates the clinical and pathological features of human aortic dissection, making it a valuable tool for preclinical research in diagnostics, pathophysiology, and treatment development.

Introduction . Acute aortic dissection is a current and urgent problem in modern cardiac surgery. In the early stages of the dissection, the surgeon is faced with the dilemma of choosing the volume of intervention from the ascending part reconstruction only or radically ascending and aortic arch replacement. Hybrid systems for one-stage reconstruction of the thoracic aorta are currently being actively developed. The Frozen Elephant Trunk (FET) technique allow us to replacement ascending and arch of the aortae combined with antegrade stent grafting into the descending aorta from the classical sternotomy access. This type of operation doesn’t increase the time of the intervention, there isn’t stage-by-stage reconstruction of the aorta, adequate blood flow in the descending aorta and aortic vessels is restored, and the risks of an adverse outcome are reduced. Objective . To analyze the results of surgical treatment of acute aortic dissection type A, performed using the FET technique in a multidisciplinary surgical hospital – N.V. Sklifosovsky Research Institute for Emergency Medicine. Material and methods . The research included 18 patients which were operated from 2022 to 2024 in acute stage of aortic dissection. All patients were operated using a hybrid technique FET. Results . Multisystem organ failure developed in 5 patients (27.8%). Four patients (22.2%) required renal replacement therapy due to acute renal failure. In 38.9% of the subjects, prolonged artificial ventilation was complicated by pneumonia. Cerebral complications were observed in 6 patients (33.3%). Sepsis accompanied the course of the disease in 16.7% of cases. The 30-day mortality was 22.2%, in the study group. Conclusion . Using the hybrid prosthesis allowed us to obtain relatively satisfactory results of reconstruction thoracic aortae in case of the acute dissection in the early postoperative period.

Relationship of aortic outflow tract size on point-of-care ultrasound to aortic dissection diagnosis.

To evaluate the technical feasibility, safety, and short-term to mid-term efficacy of the antithrombogenic-coated CARESTO stent in the endovascular treatment of acute symptomatic cervical internal carotid artery dissections (CICAD) with hemodynamically relevant stenosis and disabling neurological deficits. This retrospective multicenter study evaluated patients with acute symptomatic CICAD who underwent endovascular treatment with the CARESTO stent. Clinical endpoints included changes in the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) scores. Imaging endpoints assessed vessel patency, arterial diameter improvement, and revascularization success, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2b. Safety was evaluated by documenting periprocedural complications. Between January 2023 and May 2025, 31 patients were treated across six participating neurovascular centers. The mean age was 52.3±10.2 years; 54.8% were female. Stent deployment was successful in all cases. In those with intracranial vessel occlusion (n=22), recanalization was achieved in all patients (mTICI 3: 61.3%; mTICI 2c: 22.6%; mTICI 2b: 16.1%). ICA diameter improved from 1.0±0.5 mm to 4.6±0.6 mm. Median NIHSS score decreased from 11 (IQR 8-14.5) to 1 (IQR 1-3) at 3 months; mRS≤2 was achieved in 83.9%. All stents remained patent, with no major complications or deaths. This initial multicenter experience suggests that the CARESTO stent is technically feasible and may offer a safe and effective treatment option for acute CICAD. These findings support further prospective evaluation in larger cohorts.

Role of aortic distensibility and stiffness in ascending thoracic aneurysm outcomes

Aortopathy encompasses a wide spectrum of genetic and heritable conditions that predispose individuals to aortic dissections and aneurysms. These include bicuspid aortic valve-associated aortopathy, nonsyndromic heritable thoracic aortic disease (HTAD), and syndromic HTAD. Syndromic heritable thoracic diseases include Marfan syndrome, Turner syndrome, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. In contrast, nonsyndromic HTAD is due to pathogenic variants in genes such as acetyl coenzyme a cholesterol acyltransferase-2, forkhead-related transcription factor 8, lysine oxidase, protein kinase cGMP-dependent 1, and myosin light chain kinase. Pregnancy-related aortic events are rare, but they account for a disproportionate share of maternal cardiovascular deaths. Profound hormonal and hemodynamic changes-including increased blood volume, cardiac output, and arterial wall stress-amplify underlying genetic risks. Acute dissection, while infrequent, remains one of the leading causes of maternal mortality, and aneurysms pose additional challenges given their silent progression until rupture. Guideline-directed management strategies-including preconception counseling, imaging surveillance, pharmacologic blood pressure control, and delivery planning-are essential for optimizing maternal and fetal outcomes. This review summarizes current evidence on the epidemiology, risk stratification, and management of aortopathy in pregnancy, emphasizing the importance of early recognition and multidisciplinary care.

Thoracic aortic diseases: Identification of diagnostic biomarkers using proteomic analysis.

The perivascular fat attenuation index (FAI) has been recognized as a cardiac computed tomography-based (CCT)-based biomarker of coronary inflammation. We report the case of a 47-year-old woman with acute spontaneous coronary artery dissection (SCAD) involving the proximal left coronary artery (LCA), who underwent FAI three times. The initial CCT scan revealed higher perivascular FAI values in the dissected LCA. The second CCT scan, performed 8 days later, showed persistence of a higher perivascular FAI value only in the left circumflex coronary artery, in which progression of stenotic severity and myocardial infarction formation were found. The persistence of a higher perivascular FAI may indicate disease deterioration in patients with SCAD.

The modified Cabrol technique has been associated with excellent graft patency. However, prior studies were limited to patients largely on long-term anticoagulation. We sought to analyze outcomes in patients primarily managed without mechanical prostheses. We retrospectively analyzed all patients who underwent aortic root replacement by a single surgeon from 2014 to 2024. Patients who underwent reimplantation of one or both coronary ostia using the modified Cabrol technique with separate interposition grafts were identified. Baseline characteristics and postoperative outcomes were reported. Predictors of mortality were analyzed using Cox proportional hazards, and overall survival was reported using Kaplan-Meier analysis. We identified 91 patients who underwent the modified Cabrol technique. The median age was 62 [interquartile range, 52-71] years, and 91.2% (83/91) were male. Patients presented urgently or emergently in 38.5% (35/91) of cases, and for acute dissection in 23.1% (21/91) of cases, and endocarditis in 15.4% (14/91). Patients required redo sternotomy in 50% of cases. A mechanical composite valve graft was used in only 7.7% (7/91) of patients. The incidence of long-term myocardial infarction was 4.4% (4/91). Survival at 1 and 5 years was 93% and 89% respectively. There was no significant association with the utilization of Cabrol graft and long-term mortality (Hazard Ratio 1.74, 95% CI 0.76-4.01, p-value 0.219). Patients undergoing the modified Cabrol technique had an acceptable risk of mortality in short- and midterm follow-up. The modified Cabrol technique is a valuable tool in an aortic surgeon's arsenal and should be used selectively.

Diagnostic performance of coronary CT angiography to diagnose acute spontaneous coronary artery dissection.

BackgroundThe frozen elephant trunk (FET) provides single-stage repair of complex, concomitant aortic arch and descending aortic disease, integrating both conventional and endovascular approaches. While multiple meta-analyses affirm short-term safety, long-term outcomes remain largely unknown, especially regarding overall survival and freedom from re-intervention. This current systematic review and meta-analysis aims to summarize the short- and long-term outcomes following the use of FET in aortic pathology.MethodsStudies with at least two years of follow-up data on FETs were identified in five electronic databases, which were searched from inception of records until July 2025. The primary outcome of interest was mortality, with short-term data presented as either 30-day or in-hospital mortality, and long-term data as aggregated Kaplan-Meier curves. Subgroup analysis was also compared by etiology. Secondary outcomes included relevant morbidity outcomes.ResultsFollowing independent screening, 28 studies were included for analysis, with 11,292 patients and a mean follow-up period of 40.4 months. Actuarial overall survival at 1, 5 and 10 years was 86.2%, 78.8% and 67.9%, respectively. Long-term survival for acute dissection for these points was marginally higher, at 86.2%, 82.4%, and 75.2%, respectively. Overall freedom from distal reintervention at 1, 5, and 10 years was 93.9%, 87.4% and 81.5%, respectively. Comparatively, pooled short-term mortality was marginally higher in the aortic dissection cohort than the overall cohort at 7.7% [95% confidence interval (CI): 6–11%] and 7% (95% CI: 5–9%), respectively. The breakdown for these was 254/3,379 and 742/9,428 patients, respectively. For the overall cohort, postoperative spinal cord injury (SCI), postoperative cerebrovascular accident (CVA), and acute renal failure (ARF) requiring dialysis were 4%, 8% and 11%, respectively. Pooled mean intensive care unit (ICU) length of stay was 7 days. A high level of heterogeneity was present, likely due to the mixed etiologies included.ConclusionsOur long-term data expands on previous literature while affirming similar favorable long-term survival for the FET procedure. The consistent pattern of improved late-survival in acute dissections supports the hypothesis that early false-lumen exclusion and acute remodeling result in clear long-term benefits. The need for re-intervention has remained consistent with the published literature, further highlighting the importance of patient selection.

Surgical experience and long-term outcomes of retrograde type A aortic dissection after thoracic endovascular aortic repair

Management and outcomes of thoracic dissection in older adults.

An in-depth analysis of coronary computed tomography angiography segmental findings in acute spontaneous coronary artery dissection - a prospective multicenter study.

Rationale:Spontaneous renal artery dissection (SRAD) is a rare vascular emergency with high mortality. Early diagnosis remains challenging due to nonspecific clinical manifestations. This case highlights diagnostic and therapeutic dilemmas in managing SRAD, emphasizing the need for multidisciplinary collaboration.Patient concerns:A 35-year-old male with a history of left renal artery stenosis treated by percutaneous transluminal angioplasty 5 years prior presented with sudden right flank pain, nausea, and vomiting. Physical examination revealed abdominal tenderness and hypertension. Laboratory tests showed elevated homocysteine (27.8 μmol/L).Diagnoses:Contrast-enhanced computed tomography confirmed the presence of a longitudinal intimal flap in the main trunk of the right renal artery with complete distal occlusion and extensive renal infarction. No signs of aortic coarctation, mesenteric ischemia, or pulmonary embolism were found.Interventions:Emergency balloon angioplasty and stent implantation were performed. Postprocedure angiography showed partial recanalization of the main renal artery trunk but persistent distal branch occlusion.Outcomes:Despite intervention, the patient deteriorated rapidly, developing cardiac arrest, metabolic acidosis (pH 7.06, Lac 13.8 mmol/L), and multiorgan dysfunction syndrome. Resuscitation efforts failed, and the patient was declared dead 13 hours postadmission.Lessons:SRAD mimics acute abdomen or hypertensive crisis, requiring high clinical suspicion in patients with renovascular history. Endovascular intervention improved proximal flow but failed to restore distal perfusion, highlighting anatomical complexity. Chronic medial degeneration (evidenced by restenosis history) may predispose to acute dissection progression. Integration of imaging, laboratory trends, and surgical consultation is critical for timely intervention.

Intravenous thrombolytic therapy is an effective and safe method in the treatment of acute ischemic stroke due to dissection. Our knowledge about the clinical results and reperfusion rates of the endovascular treatment of dissection associated with intracranial vessel occlusion is limited. In our study, we aimed to present our patients with acute dissection in the etiology for which we applied endovascular treatment. Patients who underwent endovascular treatment of acute ischemic stroke due to a major vessel occlusion secondary to extracranial or intracranial vessel dissection were extrapolated from Eskisehir Osmangazi Stroke Center Database between January 2015 and May 2020. Patients' age, gender, symptom time, time of arrival to the emergency room, administration of thrombolytic therapy, admission NIHSS score, ASPECT, etiological diagnoses, thrombectomy method, recanalization rate, post-procedure intracerebral bleeding (SITS-MOST), modified Rankin score at discharge and 3 months later were recorded. A total of 13 patients with a mean age of 43 ± 9.84 years were included in the study. Of the patients, 46.1% were male (n=6) and 53.8% were female (n=7). Two patients had a history of blunt trauma within the last week. In diagnostic digital subtraction angiography (DSA), it was observed that 12 patients had internal carotid artery dissection. One patient had vertebrobasilar occlusion due to dissection of V4 segment of vertebral artery. TPA was applied to 15% (n=2) of the patients. There were contraindications for tPA in 30% of the patients (n=4). Thromboaspiration method was applied in 46.1% of the patients (n=6) as the first technique in the procedure (Figure 4). Isolated stent was applied in 23% of the patients (n=3) as the first technique. Combined technique was applied in 30% (n=4) of the patients. First pass recanalization rate was found to be 38.4% (n=5). Two or more intracranial procedures had to be performed in 58.3% of the patients (n=7). The rate of complete recanalization (TICI 2b-3) was 92.3% (n=12). Recanalization could not be achieved in one patient. First pass recanalization rate was 38.4% (n=5). Clinical progression and worsening of symptoms due to bleeding (NIHSS> 4) were not observed. The rate of patients who were living independently (mRS ≤2) was 76.9% (n=10). Endovascular treatment of acute ischemic stroke due to dissection is effective and safe. More studies are needed to evaluate the effectiveness of endovascular therapy and to identify techniques that provide better clinical outcomes.

Proximalization of the distal anastomosis in frozen elephant trunk surgery

Early experience with a prefabricated bioprosthetic aortic valved conduit: The first 100

Balloon angioplasty alone in carotid artery dissections: an overlooked therapeutic choice in acute ischemic stroke.