Stanford classification of aortic dissection
Along with the DeBakey classification, the Stanford classification 7 is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management. The Stanford classification divides dissections by the most proximal involvement:
-
type A: A affects ascending aorta
- accounts for ~60% of aortic dissections
- surgical management
- may result in:
- coronary artery occlusion
- aortic incompetence
- rupture into the pericardial sac with resulting cardiac tamponade
-
type B: B begins beyond brachiocephalic vessels
- accounts for ~40% of aortic dissections
- dissection commences distal to the left subclavian artery
- medical management with blood pressure control
A special case that is neither reflected in the original Stanford nor the DeBakey classification are dissections that involve the aortic arch but not the ascending aorta (between 8 and 15% of all aortic dissections 4). The nomenclature of these arch dissections has been incoherent for decades and still is.
American surgical consensus (2020) 5 defines types A and B according to the location of the intimal tear (both types with additional qualifiers for proximal and distal extent):
- type A: dissections with a tear in the ascending aorta including a segment with the branching of the brachiocephalic trunk
- type B: all dissections with proximal tear distal to the branching of the brachiocephalic trunk
In contrast, a European surgical consensus document (2018) 6 recognizes dissections of the arch without involvement of the ascending aorta as a distinct category, termed "non-A-non-B dissection":
- type A: proximal extent in ascending aorta
- non-A-non-B dissection: retrograde extent or proximal tear in the arch between the brachiocephalic trunk and left subclavian artery
- type B: proximal extent in descending aorta distal to left subclavian artery
Related Radiopaedia articles
Aortic pathology
- acute aortic syndrome
- aortic aneurysms
- inflammatory
- congenital
- aortic coarctation
- aortic pseudocoarctation
- cervical aortic arch
- interrupted aortic arch
- transposition of the great arteries
- variant anatomy of the aortic arch
- traumatic aortic injury
- miscellaneous