Stanford classification of aortic dissection

Last revised by Assoc Prof Craig Hacking on 29 Apr 2021

The Stanford classification, along with the DeBakey classification, is used to separate aortic dissections into those that need surgical repair, and those that usually require only medical management 7.

Both the Stanford and DeBakey systems can be used to describe all forms of acute aortic syndrome (dissection, aneursym, penetrating atherosclerotic ulcer and intramural hematoma).

Classification

The Stanford classification divides dissections by the most proximal involvement: type A involves any part of the aorta proximal 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:
  • 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

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Cases and figures

  • Figure 1: type A
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  • Figure 2: type B
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  • Case 1: type A
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  • Case 2: type B
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  • Case 3: type B
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  • Case 4: type A
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  • Case 5: type A
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  • Case 6: type A
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  • Case 7: type A
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  • Case 8: type B
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  • Case 9: type A
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  • Case 10: type A
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  • Case 11: type A
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