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Current management of aortic repair relies on an aortic diameter threshold. However, this approach underestimates the complexity of aortic wall disease due to important knowledge gaps in understanding its underlying pathologic mechanisms.<\/jats:p>\n                  <jats:p>Since traditional risk factors cannot explain the initiation and progression of ATAA leading to dissection, local vascular factors such as extracellular matrix (ECM) and vascular smooth muscle cells (VSMCs) might harbor targets for early diagnosis and intervention. Derived from diverse embryonic lineages, VSMCs exhibit varied responses to genetic abnormalities that regulate their contractility. The transition of VSMCs into different phenotypes is an adaptive response to stress stimuli such as hemodynamic changes resulting from cardiovascular disease, aging, lifestyle, and genetic predisposition. Upon longer exposure to stress stimuli, VSMC phenotypic switching can instigate pathologic remodeling that contributes to the pathogenesis of ATAA.<\/jats:p>\n                  <jats:p>This review aims to illuminate the current understanding of cellular and molecular characteristics associated with ATAA and dissection, emphasizing the need for a more nuanced comprehension of the impaired ECM\u2013VSMC network.<\/jats:p>","DOI":"10.1007\/s00395-024-01053-1","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T07:01:54Z","timestamp":1714719714000},"page":"371-395","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Unveiling cellular and molecular aspects of ascending thoracic aortic aneurysms and dissections"],"prefix":"10.1007","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4614-2146","authenticated-orcid":false,"given":"Berta H.","family":"Ganizada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogier J. 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