Early Dynamic Changes in Haematoma Thickness in Medically Managed Type A Intramural Haematoma: A Multicentre Retrospective Study.

objectivesThis study aimed to investigate changes in haematoma thickness (HT) and the maximum ascending aortic diameter (MAD) early after onset and their association with in-hospital disease progression in type A intramural haematoma (IMH).

methodsMedical records and serial computed tomography angiography (CTA) scans of 140 patients treated from April 2011 to June 2023 at 6 hospitals in Japan were retrospectively analysed. Remodelling rates (mm/h) for HT and MAD were calculated using the first 2 CTAs divided by the scan-interval time. Disease progression during hospitalization was defined as new ulcer-like projections, haematoma enlargement, false lumen aortic recanalization of the ascending aorta, or aortic rupture. Associations within these parameters and in-hospital disease progression were evaluated.

resultsThe mean MAD was 44.2 ± 4.9 mm, and HT was 8.1 ± 4.1 mm. In-hospital disease progression occurred in 35/140 patients (25%), and overall in-hospital mortality was 12/140 (9%). Aortic remodelling was analysed in 129/140 patients. Both HT and MAD demonstrated rapid early negative remodelling and were significantly associated with time from onset, whereas maximum values of HT and MAD within 24 hours indicated no significant correlation with time from onset. Logistic regression revealed that HT and its remodelling rate did not predict in-hospital disease progression; only the MAD remodelling rate was an independent predictor (OR, 0.71 per 0.1 mm/h, 95% CI, 0.52-0.94; P = .025).

conclusionsHT may have limited utility as a single-time-point imaging marker for early risk stratification, and repeated early morphological assessment may be useful in selected medically managed patients with type A IMH.