Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events

Abstract

Background Medical treatment of initially uncomplicated acute Stanford type-B aortic dissection is associated with a high rate of late adverse events. Identification of individuals who potentially benefit from preventive endografting is highly desirable. Methods and Results The association of CT imaging features with late adverse events was retrospectively assessed in 83 patients with acute uncomplicated Stanford type-B aortic dissection, followed over a median of 850 (IQR 247–1824) days. Adverse events were defined as fatal or non-fatal aortic rupture, rapid aortic growth (>10 mm/year), aneurysm formation (≥6 cm), organ or limb ischemia, or new uncontrollable hypertension or pain. Five significant predictors were identified using multivariable Cox regression analysis: connective tissue disease (HR 2.94, 95%CI: 1.29–6.72, p=0.01), circumferential extent of false lumen in angular degrees (HR 1.03 per degree, 95%CI: 1.01–1.04, p=0.003), maximum aortic diameter (HR 1.10 per mm, 95%CI: 1.02–1.18, p=0.015), false lumen outflow (HR 0.999 per mL, 95%CI: 0.998–1.000, p=0.055), and number of intercostal arteries (HR 0.89 per n, 95%CI: 0.80–0.98, p=0.024). A prediction model constructed to calculate patient specific risk at 1, 2 and 5 years and to stratify patients into high, intermediate, and low risk groups. The model was internally validated by bootstrapping and showed good discriminatory ability with an optimism-corrected c-statistic of 70.1%. Conclusions CT imaging-based morphologic features combined into a prediction model may be able to identify patients at high risk for late adverse events after an initially uncomplicated type B aortic dissection.

False lumen intervention to promote remodelling and thrombosis—The FLIRT concept in aortic dissection

“…Advanced interventional skills, with formal training in interventional cardiology, are also essential for safe interventions. Finally, best timing of FLIRT as complimentary intervention is not clear yet, but better understanding of CT imaging may help to identify patients likely to benefit from FLIRT .…”

“…Closure of entry tears, restoration of single-lumen blood flow and enhanced FL thrombosis may reap long-term benefits [33], without the risks of stent-grafting the ascending aorta ( Figure 4). Finally, best timing of FLIRT as complimentary intervention is not clear yet, but better understanding of CT imaging may help to identify patients likely to benefit from FLIRT [34,35].…”

Critical appraisal of multidimensional CT measurements following acute open repair of type A aortic dissection

“…Moreover, the sizing of stent‐grafts in the case of early endovascular additional repair can be heavily misguided by simple diameter measurements, whereas area measurements may provide a more holistic approach, enabling adequate endovascular intervention. Given the variable morphology of the luminal dimensions in aortic dissection, Sailer et al 30 proposed to use the circumferential extent of the FL, reflecting the proportion of aortic wall circumference that is characterized by reduced thickness and strength. The study of Sailer et al was performed in TBAD patients and has not yet been validated in other populations of aortic dissection, including postrepair TAAD patients.…”

Extended Arch Procedures for Acute Type A Aortic Dissection: A Downstream Problem?

“…7 Similarly, indices combining multiple predictors have been shown to predict groups that have excellent late outcomes. 33,38 Patients with connective tissue disorders are at high risk for late reoperations and may be considered for extended repair. 38 Another consideration of selective treatment of ATAAD is the timing of extending hemiarch.…”