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Int J Cardiol. 2018 Oct 15;269:298-303. doi: 10.1016/j.ijcard.2018.07.111. Epub 2018 Jul 26.

Intimal disruption in type B aortic intramural hematoma. Does size matter? A systematic review and meta-analysis.

Author information

Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona. Electronic address:
Radiology Department, Centre d'Atenció Primaria Pare Claret, Institut Català de la Salut, Barcelona, Spain.
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Department of Pathology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona.
Cardiology Department, Hospital Universitari Doctor Josep Trueta, CIBER-CV, Girona.
Cardiology Department, Hospital General Universitari Vall d'Hebron, CIBER-CV, Barcelona, Spain.



Type B intramural hematoma (IMH) is considered a low-risk entity for aortic complications if aortic dilation, containing rupture or clinical instability are absent. However, the development of intimal disruptions (ID), present in >40% of cases, poses an unknown risk.


To establish which ID characteristics imply a higher risk of aortic complications and, therefore, merit invasive treatment.


A systematic review and a meta-analysis were made following a search in EMBASE, MEDLINE and PsycINFO for articles published between January 1995 and December 2017. The combined endpoint was defined as aortic mortality, invasive treatment for aortic disease and/or increase in maximum aortic diameter ≥55 mm. Lesions with communicating orifice ≤3 mm were defined as tiny ID (TID) and those with >3 mm as focal ID (FID).


Six studies with 564 participants diagnosed of type B IMH were included. Incidence of ID was 54.3% (306 individuals): 27.7% (156 individuals) initially met TID criteria; however, 13.9% of these (21 of 151 with morphologic evolution) evolved to FID within the first 6 months. Ninety-two cases suffered clinical aorta-related events (16.3%; mean follow-up range: 15-85 months; median: 52 months). Patients with TID had a similar risk of aorta-related events to those without ID (RR = 0.904; 95% CI, 0.335-2.440; P = 0.842; I2 = 42.5%), but lower than those with FID (RR = 0.299; 95% CI, 0.094-0.952; P = 0.041; I2 = 26.9%).


Tiny intimal disruption in type B IMH evolution is not related to an increased risk of complications and should not be considered an indication for invasive treatment. However, since 14% of TID evolve to FID within the first 6 months, close follow-up with imaging techniques is advisable.


Aorta; Endovascular treatment; Intimal disruption; Intramural hematoma; Multidetector computed tomography

[Indexed for MEDLINE]

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