Stanford classification of aortic dissection
Updates to Article Attributes
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 involves any part of the aorta proxmial to the origin of the left subclavian artery, whereas type B arises distal to this vessel origin.
In simple terms:
-
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 recognises 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
-<p>Along with the <a href="/articles/debakey-classification">DeBakey classification</a>, the <strong>Stanford classification</strong> <sup>7</sup> is used to separate <a href="/articles/aortic-dissection">aortic dissections</a> into those that need surgical repair, and those that usually require only medical management.</p><p>The Stanford classification divides dissections by the most proximal involvement: type A involves any part of the aorta proxmial to the origin of the left <a title="Subclavian artery" href="/articles/subclavian-artery">subclavian artery</a>, whereas type B arises distal to this vessel origin.</p><p>In simple terms:</p><ul>- +<p>Along with the <a href="/articles/debakey-classification">DeBakey classification</a>, the <strong>Stanford classification</strong> <sup>7</sup> is used to separate <a href="/articles/aortic-dissection">aortic dissections</a> into those that need surgical repair, and those that usually require only medical management.</p><p>The Stanford classification divides dissections by the most proximal involvement: type A involves any part of the aorta proxmial to the origin of the left <a href="/articles/subclavian-artery">subclavian artery</a>, whereas type B arises distal to this vessel origin.</p><p>In simple terms:</p><ul>
References changed:
- 9. Ko J, Goldstein J, Latson L et al. Chest CT Angiography for Acute Aortic Pathologic Conditions: Pearls and Pitfalls. Radiographics. 2021;41(2):399-424. <a href="https://doi.org/10.1148/rg.2021200055">doi:10.1148/rg.2021200055</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33646903">Pubmed</a>
Unable to process the form. Check for errors and try again.