Search Results (208)

Objectives: This study evaluated the anatomical suitability of two single-branched thoracic stent grafts—the Castor (Endovastec, China) and the Thoracic Branch Endoprosthesis (TBE, Gore, USA)—for proximal landing in aortic arch zone 2, including the left subclavian artery (LSA), in patients with acute type B aortic dissection (TBAD). While the TBE is currently available as an off-the-shelf device (26 main bodies, 8 branch configurations), the study also aimed to define the minimal number of configurations needed to treat most patients. The same approach was applied to the Castor stent graft, currently only available as a custom-made device (CMD), to assess its potential for off-the-shelf adaptation. Methods: A retrospective analysis was performed on computed tomographic angiographies of TBAD patients treated between 2004 and 2023. Exclusion criteria included type A or non-A-non-B dissections, isolated abdominal dissections, intramural hematomas, and lack of consent. Morphometric measurements were conducted using centerline analysis software. Suitability was defined per manufacturers’ criteria and reported with 95% confidence intervals. Results: Among 100 TBAD cases, 82% (95% CI: 73.3–88.3%) were suitable for the Castor CMD with 74 configurations. Main causes of exclusion were short landing zones and atypical arch anatomies. With adjunctive procedures, 13 Castor configurations covered all morphologies; 34% could be treated off-the-shelf, and 48% required additional interventions. For the TBE, off-the-shelf suitability was 22%, increasing to 78% with adjunctive procedures (six main bodies, five branches). Conclusions: Both stent grafts are promising for proximal extension in TBAD. Reduced configuration availability necessitates more adjunctive procedures, impacting efficiency and cost. Full article

Background: Optimal cerebral protection strategies for acute Stanford type A aortic dissection (aTAAD) surgery remain controversial. This study aimed to evaluate the role of near-infrared spectroscopy (NIRS)-guided monitoring and its association with clinical outcomes. Methods: We retrospectively analyzed 619 patients undergoing aTAAD surgery (Hemi-Arch, Total-Arch, or Arch-Stent procedures). Intraoperative cerebral oxygenation was monitored using NIRS, with the magnitude of desaturation quantified as ΔNIRS. We assessed correlations between ΔNIRS and nasopharyngeal temperature, employed generalized additive models (GAM) to analyze nonlinear relationships with major adverse cardiovascular events (MACE), and used piecewise logistic regression to identify procedure-specific ΔNIRS risk thresholds. Results: ΔNIRS showed a significant positive correlation with lower temperatures in Total-Arch (R = 0.486, p < 0.001) and Arch-Stent (R = 0.216, p < 0.001) groups. GAM analysis revealed a nonlinear, accelerating relationship between higher ΔNIRS and increased log odds of MACE in Hemi-Arch and Total-Arch groups. Procedure-specific ΔNIRS thresholds were identified: 8.5% for Hemi-Arch, 19.6% for Total-Arch, and 20.9% for Arch-Stent. Patients with ΔNIRS above these thresholds had significantly higher rates of stroke and MACE. Conclusions: This study identifies ΔNIRS as a significant, procedure-dependent intraoperative monitoring indicator in aTAAD surgery, and the proposed risk thresholds provide a rationale for real-time NIRS-guided clinical decision-making. Full article

Background: Computed tomography (CT) angiography is widely regarded as the gold standard for diagnosing acute aortic dissection. However, in patients with contraindications to iodinated contrast media, such as those with renal insufficiency or hemodynamic instability, non-contrast CT may offer a viable alternative for initial evaluation. Understanding the molecular mechanisms underlying aortic dissection, including extracellular matrix degradation, smooth muscle cell apoptosis, and inflammatory pathways, is crucial for developing novel diagnostic and therapeutic approaches. This report describes a single case of acute Stanford type A aortic dissection initially detected on non-contrast CT. Case Presentation: We describe a 74-year-old man who presented to the emergency department with fever and suspected infection, but without chest pain. An incidental finding on non-contrast CT revealed ascending aortic dilatation, pericardial effusion, and a suspected intimal flap. Subsequent CT angiography confirmed a Stanford type A aortic dissection. Conclusions: This case highlights the potential value of non-contrast CT in the early detection of aortic dissection, particularly when CT angiography cannot be performed. Recent advances in artificial intelligence (AI) and radiomic analysis have shown promise in augmenting the diagnostic capabilities of non-contrast CT by identifying subtle imaging features that may correlate with underlying molecular pathology and elude human observers. Emerging evidence suggests that radiomic features may reflect molecular alterations in the aortic wall, including metalloproteinase activity, collagen degradation, and inflammatory cell infiltration. Incorporating AI-assisted interpretation alongside insights into molecular mechanisms could facilitate earlier diagnosis, improve risk stratification, and guide personalized treatment strategies in critically ill patients. Although non-contrast CT has limited sensitivity for aortic dissection, it may still reveal crucial findings in selected cases and should be considered when contrast-enhanced imaging is not feasible. Ongoing progress in AI, radiomics, and molecular biomarker research may further expand the clinical applications of non-contrast CT in emergency cardiovascular care and bridge the gap between imaging phenotypes and molecular endotypes. These findings are hypothesis-generating and require validation in larger cohorts before clinical generalization. Full article

Background and Objectives: Acute type A aortic dissection (ATAAD) remains a life-threatening condition requiring prompt surgical management. Over the last decades, improvements in diagnosis, surgical techniques, and perioperative care have influenced patient characteristics and outcomes. This study analyzes temporal trends in the clinical profiles and results of patients surgically treated for acute type A aortic dissection (ATAAD) in a Northern Italian region over a fifteen-year period. Materials and Methods: All consecutive patients undergoing emergency surgery for acute Stanford type A aortic dissection or acute intramural hematoma (IMH) between January 2010 and December 2024 were retrospectively reviewed. Patients with chronic penetrating atherosclerotic ulcer or traumatic etiology were excluded. Demographic, clinical, and perioperative variables were analyzed to assess temporal changes. Trends were evaluated using linear regression and Cochran–Armitage tests for trend. Results: A total of 427 patients underwent surgery for AAD during the study period. The proportion of patients presenting with preoperative intubation significantly decreased over time (p for trend < 0.05), as did the incidence of preoperative shock (p for trend < 0.001). Conversely, the mean EuroSCORE showed a non-significant increase over the years. No significant differences were observed in age or other baseline parameters. A non-significant but progressive increase in female representation was observed over time (p = 0.064). Given this observation, a sex-based subanalysis was performed: women were significantly older (p < 0.001) and presented with higher EuroSCORE values (p < 0.001) compared to men, yet postoperative mortality was similar between sexes. This finding contrasts with recent reports suggesting worse outcomes among female patients. Conclusions: Over fifteen years, patients undergoing surgery for acute type A aortic dissection have shown decreasing rates of preoperative critical conditions, reflecting earlier diagnosis and improved management. Despite higher operative risk scores, women demonstrated comparable short-term survival to men within our regional program. Multivariable analysis showed that sex was dependently associated with in-hospital mortality. Full article

Background: Animal models are essential for translating diagnostic and therapeutic strategies into clinical practice and offer valuable insights into the pathophysiology of diseases such as aortic dissection. This study presents a novel acute in vivo large animal model of Stanford type A aortic dissection, combining open surgical access with endovascular techniques to leverage the advantages of both. The model aims to reproducibly simulate acute dissections in swine, providing a standardized platform for evaluating diagnostics, disease mechanisms, and treatment strategies. Methods: Six pigs underwent a standardized protocol to induce aortic dissection. Arterial pressure was monitored via femoral and carotid catheterization. A conventional sternotomy was performed, followed by tangential cross-clamping of the ascending aorta and a controlled incision proximal to the brachiocephalic trunk. The intima and the media were separated using a guidewire and catheter-based technique to create a false lumen. A re-entry tear was also established to allow for controlled intraluminal access. Animals were monitored for 12 h post-intervention, with serial blood sampling. At the end of the experiment, the animals were euthanized and the aortas harvested for macroscopic and histological analysis. Results: In all 6 animals, the placement of arterial catheters in femoral and carotid arteries, as well as the sternotomy, was established without any complications. The dissection model was successfully created in 5 out of 6 animals by clinical signs such as adventitial hematoma, macroscopic wall separation and/or decreased femoral blood pressure. One animal experienced complete aortic perforation. Five animals completed the full observation period of 12 h. Conclusion: A standardized, reproducible, and robust large animal model of acute Stanford type A aortic dissection using a hybrid approach was developed. This model closely simulates the clinical and pathological features of human aortic dissection, making it a valuable tool for preclinical research in diagnostics, pathophysiology, and treatment development. Full article

Type B aortic dissection (TBAD) requires management tailored to the disease phase and clinical presentation, with the subacute period representing a favorable window for endovascular intervention due to improved procedural safety and remodeling potential. We report the case of a 38-year-old male with hypertension, dyslipidemia, and bicuspid aortic valve disease who presented one month after symptom onset with persistent chest pain and progressive bilateral lower-limb numbness. Clinical examination suggested early spinal cord ischemia, while laboratory tests demonstrated acute hepatic and renal dysfunction. CT angiography revealed a subacute TBAD with a markedly expanded false lumen and near-complete compression of the true lumen, resulting in visceral, renal, and potential spinal malperfusion. Given the high-risk anatomy and evolving organ dysfunction, a staged hybrid strategy was undertaken. A left carotid–subclavian bypass was performed to secure proximal landing for endovascular repair, followed the next day by thoracic endovascular aortic repair (TEVAR) using two thoracic stent grafts. Postoperative recovery was favorable, with rapid resolution of neurological symptoms and normalization of hepatic and renal parameters, allowing discharge on postoperative day seven. This case underscores the importance of early recognition of malperfusion and timely hybrid intervention in subacute TBAD with severely compressed true lumen, demonstrating excellent early clinical outcomes. Full article

Objective: This study aimed to evaluate clinical and radiological outcomes of Ascyrus Medical Dissection Stent (AMDS^®, Artivion Inc.) for acute type A aortic dissection (ATAAD). Methods: Between January 2021 and January 2025, all consecutive patients undergoing emergent surgery for ATAAD and hybrid aortic arch repair using the AMDS from two centers were retrospectively analyzed. Demographic, intraoperative, and postoperative data were collected. Patients were stratified based on 30-day or in-hospital mortality. Survival analysis was performed for patients who survived hospital discharge. Radiological evaluation focused on the presence of distal anastomotic new entries (DANEs), false lumen thrombosis, and aortic remodeling on follow-up computed tomography angiography. A total of 46 patients (12 female, mean age 66.1 ± 13.8 years) were included in the study. Results: The 30-day or in-hospital mortality rate was 21.7% (10 patients). There were no significant differences in demographic variables between survivors and non-survivors. All patients underwent hemiarch replacement with AMDS stent placement, with 54.3% also requiring aortic root replacement. Median cross-clamp time, hypothermic circulatory arrest (HCA) time, and time of antegrade selective cerebral perfusion did not differ significantly between the two groups. However, significant differences were observed in median cardiopulmonary bypass (CPB) time (151 vs. 274 min, p = 0.02) and HCA temperature (27 °C vs. 25 °C, p = 0.021). Postoperatively, the non-survivor group showed a significantly higher incidence of dialysis requirement (7.7% vs. 60.0%, p = 0.02), use of mechanical circulatory support (3.9% vs. 44.4%, p = 0.01), and re-exploration for bleeding (15.4% vs. 66.7%, p = 0.023). Conclusions: The AMDS^® is an effective adjunct in hemiarch replacement for ATAAD. Moderate hypothermia and optimized perfusion were linked to better early survival, while the device reliably promoted true-lumen expansion with few DANEs. Its rapid deployment may further facilitate the use of moderate hypothermia by balancing procedural efficiency with systemic protection. Full article

Thoracic aortic aneurysms (TAAs) carry a high risk of fatal rupture, necessitating improved preoperative risk stratification. This study evaluates the predictive value of systemic risk scores—specifically the Model for End-Stage Liver Disease (MELD) and the Charlson Comorbidity Index (CCI)—for in-hospital mortality, length of stay, and one-year mortality in patients undergoing elective ascending aortic surgery. The study further compares MELD variants (MELD-Na and MELD-XI) for their prognostic performance in this context. This retrospective single-center study analyzed digital medical records of 500 patients undergoing elective surgery for ascending thoracic aortic disease between 2003 and 2023. MELD, MELD-Na (incorporating sodium), and MELD-XI (excluding INR for anticoagulated patients) were calculated from preoperative laboratory data. The CCI was derived from documented comorbidities. Outcomes included in-hospital mortality, length of stay (from admission to discharge), and one-year mortality assessed via outpatient follow-up. The study excluded patients undergoing emergency surgery for Stanford type A aortic dissection. MELD-Na incorporates serum sodium, while MELD-XI is a variant that excludes INR for patients with anticoagulation. The Charlson Comorbidity Index (CCI) was derived from patients’ medical histories prior to surgery. Length of stay was defined as total inpatient days between admission and discharge. One-year mortality was assessed via outpatient follow-up data. Loss to follow-up did not exceed 30%. Of 500 patients (median age 64 years, 72.8% male), the MELD-Na score showed the strongest ability to predict in-hospital mortality (AUC = 0.698), outperforming both the standard MELD (AUC = 0.690) and the age-adjusted CCI (AUC = 0.631). For one-year mortality (N = 355), MELD-Na again performed best (AUC = 0.732), while the unadjusted CCI showed minimal predictive value (AUC = 0.509). Predictive power for hospital length of stay was limited across all scores; the age-adjusted CCI achieved the highest, though modest, discrimination (AUC = 0.627). 1-year mortality was assessed in 355 patients with available follow-up data (29.0% lost to follow-up). Among these, non-survivors had significantly higher MELD scores (p < 0.001). MELD-Na demonstrated the strongest predictive performance (AUC = 0.732). The MELD score, particularly MELD-Na, demonstrated strong predictive ability for in-hospital and 1-year mortality, but showed limited value in estimating hospital stay duration. MELD-Na and the age-adjusted CCI provide valuable preoperative prognostic information for patients undergoing elective ascending aortic surgery. While not intended to replace established risk models, their simplicity and reliance on routine clinical data make them attractive tools for early triage, especially in older or multimorbid patients. Their integration into preoperative planning may enhance individualized risk assessment and resource allocation. Full article

Transcatheter aortic valve implantation is rapidly emerging as the leading treatment for severe aortic valve stenosis, especially in elderly and high-risk or inoperable patients. Prosthetic embolism is a rare but serious complication of transcatheter aortic valve replacement. Patients who develop prosthetic embolism are at increased risk of mortality and morbidity. These include stroke and aortic dissection associated with manipulation of the prosthesis in the ascending aorta. Treatment of valve embolisms into the aorta may differ depending on the type of valve; however, it traditionally relies on repositioning the valve to an appropriate position. To date, there are no established pharmaceutical guidelines for the management of patients with valve prosthesis embolization. We present a case report of the implantation of a second aortic valve prosthesis after periprocedural embolization of the first transcatheter valve, resulting in residual floating in the ascending aorta and following treatment with oral anticoagulation as well as single antiplatelet therapy due to the increased risk of thrombogenesis. This case report provides an example of the management of a transcatheter valve embolization with residual floating and highlights the need for further studies to address this issue. Full article

Background and objectives: In cases of acute type A aortic dissection, including iatrogenic cases following transcatheter procedures, the choice of arterial cannulation site has a critical influence on early haemodynamics, organ protection and the risk of malperfusion. Transapical left ventricular cannulation has been suggested as a ‘central’ approach for rapidly establishing cardiopulmonary bypass with antegrade true-lumen flow. This review summarises the current evidence on TAC in acute type A dissection, focusing on indications, technical aspects and clinical outcomes. Materials and methods: We conducted a narrative review of observational studies and technical reports describing TAC for the surgical repair of acute type A aortic dissection. Particular attention was paid to patient selection, operative technique, perioperative complications, and early and mid-term results. Results: Across the published series, TAC is primarily employed in haemodynamically unstable patients or when the peripheral arteries are dissected, diseased, or unsuitable. A long arterial cannula is introduced through the left ventricular apex, crosses the aortic valve and is positioned in the true lumen of the ascending aorta under echocardiographic guidance. This configuration enables the rapid initiation of CPB, shortens skin-to-pump times, and provides reliable antegrade inflow. Early mortality and stroke rates are comparable to those associated with other cannulation strategies. Reported complications include malperfusion requiring site conversion, apical bleeding and rare local structural damage. These can be minimised through standardised technique and systematic imaging. Conclusions: TAC is a valuable bail-out option and, in selected patients, a primary cannulation option for acute type A aortic dissection when conventional arterial access is unsafe or ineffective. Although it offers fast and reproducible establishment of antegrade true-lumen flow, it requires specific expertise in apical exposure and intraoperative echocardiography. It should therefore be integrated into a structured perfusion and repair strategy. Full article

Background: Cefiderocol, a novel siderophore cephalosporin, has shown promising activity against multidrug-resistant (MDR) Gram-negative pathogens, including metallo-β-lactamase (MBL) producers. However, emerging reports suggest rapid resistance development under selective pressure, particularly in epidemic Pseudomonas aeruginosa lineages. Case presentation: We describe a 50-year-old man with a history of aortic dissection who developed ventilator-associated pneumonia due to P. aeruginosa ST175 carrying an IMP-type carbapenemase. Initial treatment with ceftazidime/avibactam plus aztreonam was followed by cefiderocol monotherapy. Although the patient showed early improvement, clinical relapse occurred within days, with subsequent isolation of cefiderocol-resistant P. aeruginosa. Whole-genome sequencing revealed high-impact mutations in iron acquisition systems (including fptA and pvdE) and multiple resistance determinants (oprD, efflux pump regulators, ampD/ampR), disrupting siderophore-mediated uptake and favoring multidrug resistance. Despite rescue therapy with ceftazidime/avibactam plus aztreonam and adjunctive agents, the patient ultimately died from septic shock and multiorgan failure. Discussion: This case highlights the ability of high-risk P. aeruginosa clones to rapidly adapt to cefiderocol, driven by combined alterations in iron metabolism and classical resistance pathways. The development of resistance within less than one week of exposure underscores the risk of using cefiderocol as monotherapy in infections caused by epidemic MDR clones. Conclusions: Cefiderocol resistance can emerge rapidly in vivo during treatment of infections caused by P. aeruginosa ST175. Continuous surveillance, molecular characterization of resistance mechanisms, and cautious use of cefiderocol—preferably in combination regimens—are warranted to preserve its clinical utility. Full article

Background: The Sandwich technique is a commonly adopted method for reinforcing the dissected aortic wall during acute Type A aortic dissection (ATAAD) repair, using either felt or bovine pericardial strips. However, complications such as anastomotic bleeding, distal anastomotic new entry (DANE) and persistent false lumen (PFL) remain major challenges. This study evaluated and compared the sealing efficacy of felt versus pericardium in a human cadaver model. Methods: ATAAD was simulated in 20 fresh human cadavers. Repairs were performed using the sandwich technique with either felt (n = 10) or pericardium (n = 10), followed by end-to-end prosthetic graft anastomosis. Procedure time was recorded. Following the repair, the aortas were perfused at 160/90 mmHg using a glycerol-water solution to assess fluid leakage (mL), DANE and PFL. Results: Median leakage was significantly lower in the pericardium group (67.5 mL [IQR 40–198.8]) compared to the felt group (315 mL [IQR 285–445], p = 0.002). Procedure times were comparable between groups. DANE occurred in 20% (pericardium) and 30% (felt) of cases, while PFL was observed in 30% of cases in both groups; differences were not statistically significant. Conclusions: The superior sealing properties of pericardium in this study suggest a promising approach for reducing leakage in ATAAD repair. While rates of DANE and PFL were comparable, the advantage of pericardium was confined to leakage reduction. These findings highlight the need for further research to determine whether this experimental benefit translates into improved clinical outcomes. Full article

Background/Objectives: Total arch replacement (TAR) with frozen elephant trunk (FET) using the E-vita Open hybrid prosthesis represents a complex surgical intervention for extensive aortic pathologies in previously operated patients. The comparative safety profile between patients with previous acute Type A dissection repair versus other cardiac surgical histories remains unclear. This pilot study evaluated early and midterm outcomes to determine whether previous aortic dissection carries additional operative risk compared to other previous cardiac operations. Methods: This retrospective single-center pilot cohort study analyzed 27 patients who underwent TAR with E-vita Open hybrid prosthesis between January 2013 and June 2024. Patients were stratified into two groups: Group 1 comprised patients with previous acute Type A dissection repair (n = 15, 55.6%), and Group 2 included patients with other previous cardiac operations (n = 12, 44.4%). Primary endpoints were in-hospital mortality and survival at 1, 2, and 3 years. Secondary endpoints included major neurological complications, spinal cord injury, reoperation for bleeding, and freedom from aortic reinterventions. Results: Baseline characteristics demonstrated comparable risk profiles between groups, with similar EuroSCORE II values (median 4.55 [IQR 3.86–7.28] vs. 5.41 [IQR 3.93–6.74], p = 1.0). Despite Group 1 showing trends toward longer operative times (580.07 ± 126.84 vs. 481.25 ± 119.29 min, p = 0.053), major postoperative outcomes were statistically equivalent. In-hospital mortality was 6.7% in Group 1 versus 0% in Group 2 (p = 1.0). Stroke rates were comparable (20.0% vs. 25.0%, p = 1.0), as were paraplegia rates (13.3% vs. 8.3%, p = 1.0) and dialysis requirements (46.7% vs. 41.7%, p = 0.334). Survival rates at 1, 2, and 3 years were 80.0%, 66.7%, and 60.0% for Group 1 and 75.0%, 66.7%, and 50.0% for Group 2, respectively (all p > 0.05). Conclusions: This pilot study suggests preliminary evidence of comparable early and midterm outcomes between patients with previous Type A dissection repair and those with other previous cardiac operations when undergoing TAR with E-vita Open hybrid prosthesis at an experienced center. However, the small sample size limits definitive conclusions and highlights the need for larger multicenter studies to confirm these findings. Full article

Background: The treatment of thoraco-abdominal aortic aneurysms (TAAAs) and chronic type B aortic dissections (TAAD), is technically challenging. Traditional open surgery repair carries high morbidity and mortality rates, while endovascular repair is limited by anatomical constraints. This study investigates the safety and effectiveness of a hybrid approach in high-risk patients with TAA disease and complex renal and hypogastric anatomy. Methods: This was a retrospective single-center study, including all consecutive patients with TAAA and TAAD with complex renal and/or hypogastric artery anatomy treated with a hybrid approach between 2020 and 2024 in a high-volume aortic center. Primary endpoint was technical success. Secondary endpoints were early complications, overall and aortic-related mortality, aortic-related reintervention, the incidence of endoleaks, and the target vessel (TV) patency and TV instability at 30-day and during follow-up. Results: During the study period, a total of 92 patients with TAAA or TAAD were treated at our institution. Five high-risk patients (5.4%) with complex renal/hypogastric artery anatomy underwent open renal debranching and hypogastric revascularization followed by staged endovascular repair with custom-made double fenestrated/branched device. Technical success was achieved in all cases with no intra-operative mortality. No spinal cord ischemia or 30-day mortality occurred. Target vessel patency at 30 days was 90%. At a median follow-up of 38 months (IQR 26–49 months), there were no cases of aortic-related death. Conclusions: Hybrid repair is a feasible and effective option for managing complex TAAA and TAAD in high-risk patients. Larger studies with longer follow-up are needed to better define the clinical role of this approach. Full article

Background: Computed tomography (CT) is the standard of reference for diagnosis and follow-up in aortic dissection (AD). Localizing the entry and identifying false and true lumen are as important as differing post-treatment changes from contrast media extravasations. Photon-counting detector CT (PCDCT) allows for virtual monoenergetic (VME) reconstructions, which can augment contrast media effects on lower energy levels, and for virtual non-contrast (VNC) reconstructions. The aim of this study was to analyze the influence of VME reconstructions on contrast media effects in different dissection compartments as well as compare true and VNC series in AD patients. Methods: We retrospectively analyzed PCDCT datasets from 28 patients with aortic dissections, with different dissection types and different treatment statuses. Attenuation and standard deviation values of the ascending and descending aorta, as well as CT values of the false lumen, were measured. These measurements were obtained from VME images at energy levels ranging from 40 to 190 keV in 10 keV increments, as well as from non-contrast (NC) and VNC reconstructions. The signal-to-noise ratio (SNR) was calculated. Additionally, subjective values for dissection assessability and native aspects of the images were acquired for different reconstructions. Results: CT values decreased with higher energy levels in VME imaging. Ascending aorta showed higher attenuation values than descending aorta, which was higher than false lumen (e.g., at 70 keV ascending 357 [310; 419] HU, descending 346 [305; 401] HU and false lumen 298 [248; 363] HU). These differences increased on lower VME reconstructions with statistical significance for the comparisons of ascending and descending aorta with the false lumen on all energy levels. In line with this, SNR showed highest values for ascending aorta compared to descending aorta and false lumen on all energy levels. For NC comparisons, VNC and VME at 190 keV reconstructions showed higher CT values than NC reconstructions (e.g., overall data NC 48 [42; 55] HU, VNC 66 [57; 73] HU, 190 keV 97 [89; 105] HU). Subjective ratings were worse with VNC than with NC images. Conclusions: VME reconstructions on lower energy levels can be helpful in differentiating between true and false lumen in aortic dissections. Full article