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By contrast, delamination was characterized by marked separation of elastic lamellae along a single plane with damage to cells and fibrillar matrix restricted to adjacent laminae. Aging, aortic dilatation, and family history associated with lower pressures causing delamination, whereas a diagnosis of hypertension associated with higher pressures suggesting resilience to dissection. Collagen fraction adjacent to delamination correlated with higher pressures as did decreased smooth muscle cell density and increased glycosaminoglycan fraction, although several clinical and histological variables were interrelated. Protein cross-linking strengthened and enzymatic digestion of collagen weakened the aortic wall, while acute cell lysis with detergent had no effect. We conclude that increased functional medial collagen has an adaptive protective role in aortic remodeling rather than signifying medial degeneration.<\/jats:p>","DOI":"10.64898\/2026.05.12.724717","type":"posted-content","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T22:00:18Z","timestamp":1778882418000},"source":"Crossref","is-referenced-by-count":0,"title":["Increased medial collagen enhances aortic resilience against mural delamination from hydraulic fracturing"],"prefix":"10.64898","author":[{"given":"Alan","family":"Chou","sequence":"first","affiliation":[{"name":"Department of Surgery (Cardiac), Yale School of Medicine, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery (Cardiac), Yale School of Medicine, New Haven, CT, 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