Aortic Dissection after COVID-19 Vaccination

Some Injuries are for Keeps

Yesterday I met a 42-year-old optometrist who six days after the second mRNA COVID-19 vaccination suffered a distal aortic dissection.  He was healthy and was physically fit.  He knew something was wrong when back pain and leg weakness developed resulting in severe effort intolerance on vacation.   He rushed home, was hospitalized and underwent the appropriate diagnostics to determine the presence of an aortic aneurysm or widening of the aorta and then a discrete tear which blood flow now goes through the true lumen and a false lumen created by the dissection.  This occurs in the outer third of the media or the muscular layer of the blood tube.

In his mind this catastrophic event is due to the COVID-19 vaccine, and I agree.  The mRNA and Spike protein produced by the mRNA circulates in blood on average two weeks, so it is freely able to deposit in the lining of blood vessels and the vascular media of major vessels.[i] [ii] Once present, the Spike protein damages cells and incites inflammation which is a destructive process driven by white blood cells, cytokines, and complement.  It is known that the second injection is approximately 80-fold more reactogenic with fever, pain, myalgia, etc.  As part of that response, there can be a major surge in blood pressure due to release of catecholamines or stress hormones.[iii]  This increase in the change in pressure over the change in time for each heartbeat is the driving force to initiate the tear in the aorta.  Once this happens, there is no turning back, the rip goes down the major blood tube and threatens the blood supply to the spinal cord, vital organs, and legs.  Each patient is different, with some having external rupture resulting in death.  Others require emergency surgery or endovascular stenting to restore blood flow to vital organs.  In the case of the optometrist, he was managed conservatively with medications to control blood pressure.  Data from the International Registry of Acute Aortic Dissection (IRAD) indicates he faces a 22% 3-year mortality rate and this is increased by his history of prior aortic aneurysm (HR, 2.17; 95% CI, 1.03 to 4.59; P=0.04).[iv]  It is exactly this complication for which I have always advised patients with prior aortic abnormalities (aortopathies) to avoid COVID-19 vaccination.  If you know someone who has died shortly after vaccination and they had antecedent back pain or a prior aneurysm, ask the family if there was an autopsy.  This is important since aortopathies can be familial and other family members could be screened with imaging and genetic testing.  This man’s life is indelibly changed because COVID-19 vaccination was for “keeps.” 

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[i] Fertig, T.E.; Chitoiu, L.; Marta, D.S.; Ionescu, V.-S.; Cismasiu, V.B.; Radu, E.; Angheluta, G.; Dobre, M.; Serbanescu, A.; Hinescu, M.E.; Gherghiceanu, M. Vaccine mRNA Can Be Detected in Blood at 15 Days Post-Vaccination. Biomedicines 2022, 10, 1538. https://doi.org/10.3390/biomedicines10071538

[ii] Ogata AF, Cheng CA, Desjardins M, Senussi Y, Sherman AC, Powell M, Novack L, Von S, Li X, Baden LR, Walt DR. Circulating Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccine Antigen Detected in the Plasma of mRNA-1273 Vaccine Recipients. Clin Infect Dis. 2022 Mar 1;74(4):715-718. doi: 10.1093/cid/ciab465. PMID: 34015087; PMCID: PMC8241425.

[iii] Angeli F, Reboldi G, Trapasso M, Santilli G, Zappa M, Verdecchia P. Blood Pressure Increase following COVID-19 Vaccination: A Systematic Overview and Meta-Analysis. J Cardiovasc Dev Dis. 2022 May 9;9(5):150. doi: 10.3390/jcdd9050150. PMID: 35621861; PMCID: PMC9147472.

[iv] Tsai TT, Fattori R, Trimarchi S, Isselbacher E, Myrmel T, Evangelista A, Hutchison S, Sechtem U, Cooper JV, Smith DE, Pape L, Froehlich J, Raghupathy A, Januzzi JL, Eagle KA, Nienaber CA; International Registry of Acute Aortic Dissection. Long-term survival in patients presenting with type B acute aortic dissection: insights from the International Registry of Acute Aortic Dissection. Circulation. 2006 Nov 21;114(21):2226-31. doi: 10.1161/CIRCULATIONAHA.106.622340. Epub 2006 Nov 13. PMID: 17101856.