Existing and Emerging Approaches to Risk Assessment in Patients with Ascending Thoracic Aortic Dilatation

Abstract

Ascending thoracic aortic aneurysm is a life-threatening disease, which is difficult to detect prior to the occurrence of a catastrophe. Epidemiology patterns of ascending thoracic aortic dilations/aneurysms remain understudied, whereas the risk assessment of it may be improved. The electronic databases PubMed/Medline 1966–2022, Web of Science 1975–2022, Scopus 1975–2022, and RSCI 1994–2022 were searched. The current guidelines recommend a purely aortic diameter-based assessment of the thoracic aortic aneurysm risk, but over 80% of the ascending aorta dissections occur at a size that is lower than the recommended threshold of 55 mm. Moreover, a 55 mm diameter criterion could exclude a vast majority (up to 99%) of the patients from preventive surgery. The authors review several visualization-based and alternative approaches which are proposed to better predict the risk of dissection in patients with borderline dilated thoracic aorta. The imaging-based assessments of the biomechanical aortic properties, the Young’s elastic modulus, the Windkessel function, compliance, distensibility, wall shear stress, pulse wave velocity, and some other parameters have been proposed to improve the risk assessment in patients with ascending thoracic aortic aneurysm. While the authors do not argue for shifting the diameter threshold to the left, they emphasize the need for more personalized solutions that integrate the imaging data with the patient’s genotypes and phenotypes in this heterogeneous pathology.

Community-Based View on Diagnostic Imaging at the End of COVID-19 Pandemic: Online Survey-Assisted Study

“…A possible history of myocarditis may explain the persistent symptoms [34]. History of COVID-19 has been linked to an increased risk of developing aortic aneurysms [35,36]. Alarmingly, aortic strain and aortic distensibility abnormalities in the presence of SARS-CoV-2 and multisystem inflammatory syndrome may occur as early as in childhood [37].…”

Assessment of shape-based features ability to predict the ascending aortic aneurysm growth

“…The estimated pooled incidence is between 5 and 10/100,000 individuals per year ( Kuzmik et al., 2012 ; Melo et al., 2021 ). To date, the main criterion for elective ascending aortic surgery of non-urgent cases is the maximum diameter assessment whose decision threshold is generally fixed at 55 mm ( Anfinogenova et al., 2022 ). Unfortunately, this does not seem to correctly reflect the AsAA patient’s risk of rupture ( Elefteriades and Farkas, 2010 ; Tozzi et al., 2021 ) and is often considered insufficient as criterion of choice ( Sonsino et al., 2022 ).…”

Avant-Garde Endovascular Stent Graft Insertion in Dissected Ascending Thoracic Aortic Aneurysm

“…Hence, dissection of the ATAA must be fastened right after it is diagnosed to reduce its mortality rate. 4…”

“…Hence, dissection of the ATAA must be fastened right after it is diagnosed to reduce its mortality rate. 4 In consequence of these challenges, we consider that the thoracic endovascular aortic repair (TEVAR) procedure and GORE TAG thoracic stent-graft delivery (W. L. Gore & Associates, Inc., Newark, DE, USA) comprise an avant-garde formula for treating high-risk and critical patients with ATAAs. As be demonstrated, this method fostered the effectual aneurysm's thrombosis with a stent-graft properly located in the intended area.…”