Key result
In a systematic review of 36 studies, entry tear size >10mm on CTA was associated with increased false lumen flow and poor aortic remodelling in patients with aortic dissection.
Why the study?
Standard imaging provides limited data on vessel wall mechanics and haemodynamics in acute aortic dissection, whereas modern imaging and computational models may improve natural history prognostication and risk prediction.
Do modern imaging and computational models of vessel wall dynamics improve risk prediction and prognostication in healthy or dissected aortas?
Systematic Review (n=36)
Do modern imaging and computational models of vessel wall dynamics improve risk prediction and prognostication in healthy or dissected aortas?
Modern imaging and computational modelling of aortic hemodynamics show potential for predicting disease progression in aortic dissection, though standardized prospective studies are needed to establish clinical protocols.
Objective : Acute aortic dissection is a vascular emergency with unpredictable progression and outcomes. Standard imaging like computed tomography angiography (CTA) facilitates diagnosis and operative planning, but provides limited data on vessel wall mechanics and haemodynamics. Modern imaging and computational models may offer deeper insights into natural history prognostication and risk prediction. Methods : This PROSPERO-registered systematic review (CRD42024589703) followed PRISMA guidelines. Eligible MEDLINE and Embase studies assessed vessel wall dynamics or haemodynamic modelling in healthy or dissected aortas. Risk of bias was assessed using ROBINS-I; quality of evidence evaluated with GRADE. Results : 36 studies included mainly retrospective single-centre cohort studies of CT/CTA, magnetic resonance imaging (MRI), ultrasound, echocardiography and digital subtraction angiography (DSA). Entry tear size greater than 10mm on CTA was had increased false lumen flow and higher sheer wall stress causing poor aortic remodelling confirmed with 4-dimensional MRI. Distal entry tears and presence of more entry tears reduced the risk of pulsatile-type dissections, having a long-term protective effect. Helical flow patterns assessed through computational fluid dynamics (CFD) determining kinetic energy transmission increase proximal false lumen thrombosis with favourable outcomes. Conclusion : Modern imaging and modelling techniques show potential in predicting disease progression with the possibility of tailoring aortic dissection management. With most studies being exploratory in design, they could not establish replicable clinical protocols or measurable parameters. Measurements of false lumen flow, kinetic energy and entry tear features (size and number) have shown the greatest potential. Further prospective, standardised studies are essential to translate these findings into routine clinical care. Registration PROSPERO ID number CRD42024589703
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Saricilar et al. (2026) conducted a systematic review in Acute aortic dissection (n=36). Technologically enhanced assessment of vessel wall movement and mechanical function was evaluated on Vessel wall dynamics or haemodynamic modelling. In a systematic review of 36 studies, entry tear size >10mm on CTA was associated with increased false lumen flow and poor aortic remodelling in patients with aortic dissection.
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