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

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

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