CTICasesRetrograde Intimal Intussusception in Type A Aortic Dissection
Imaging findings
Thin-slice chest CT shows a communicating Type A acute aortic dissection with distinct true and false lumens. The intimomedial flap extends inferiorly into the aortic root. Motion artifact from cardiac pulsation is noted near the aortic annulus. A short segment of the proximal ascending aorta appears relatively empty of the flap. Post-operative CT following a hemiarch replacement and placement of a frozen elephant trunk graft shows persistent perfusion of the false lumen, which is fed via a small communication located at the base of the brachiocephalic artery that was present on the preoperative scan.
Key takeaways
A circumferential tear of the ascending aorta can lead to a retrograde intimomedial flap prolapse, also referred to as retrograde intimal intussusception. During diastole, this prolapsed flap can pass backward through the aortic valve, preventing proper leaflet coaptation and causing acute aortic regurgitation. Additionally, when reviewing preoperative CTs for aortic dissection, it is critical to search for and report any discrete communications or fenestrations near the head vessel origins, as their presence may prompt the surgeon to perform a complete arch replacement rather than a hemiarch to prevent persistent post-operative false lumen perfusion.
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