Suspected Aortic Dissection and Other Aortic Disorders: Multi–Detector Row CT in 373 Cases in the Emergency Setting

Hayter, Robert G; Rhea, James T.; Small, Andrew B.; Tafazoli, Faranak S; Novelline, Robert A.

doi:10.1148/radiol.2383041528

Cited by 148 publications

(80 citation statements)

References 43 publications

(51 reference statements)

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“…It provides high-quality images of the dissection flap, its origin and extent. 4 This patient illustrates the noninvasive utility in the follow-up period where CT can also show progression or regression of aortic pathology.…”

Section: Discussionmentioning

confidence: 77%

Resolution of Iatrogenic Aortic Dissection Illustrated by Computed Tomography

Garg

Buckley

Rybicki

et al. 2009

Circ: Cardiovascular Interventions

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A n 83-year-old man with known history of known coronary artery disease (prior coronary artery bypass surgery and percutaneous coronary intervention), hypertension, and hypercholesterolemia presented with ongoing exertional angina and dyspnea despite medical therapy. A dipyridamole rubidium-82 stress test showed moderate-sized ischemia in the inferior and inferolateral territory. An echocardiogram showed mild segmental left ventricular dysfunction with an ejection fraction of 45% and mild mitral regurgitation.Angiography showed severe native triple vessel disease, patent left internal mammary artery graft to left anterior descending artery, patent stents in saphenous vein graft to obtuse marginal, and occluded vein graft to right coronary artery (RCA; previously known to be occluded). The native RCA was diffusely diseased with subtotal occlusions in its mid and distal segments including severe proximal posterior descending artery disease and was partly collateralized from obtuse marginal ( Figure 1A). Given the ongoing symptoms on medical therapy, decision was made to proceed with percutaneous coronary intervention to RCA.The RCA ostium was engaged with an 8F Amplatz (AL 0.75) guide (chosen for extra support in a calcified, diffusely diseased artery), and the total occlusions in the mid and distal RCA were crossed using a PT Graphix guide wire (Boston Scientific, Natick, Mass). Rotational atherectomy with 1.50-mm burr was performed to recanalize the entire RCA from mid vessel to posterior descending artery because the mid vessel lesion could not be crossed with 1.5-mm balloon. A localized dissection was noted in the proximal RCA, most likely induced by the guiding catheter rather than atherectomy, because it was close to the edge of the guiding catheter and proximal to the segments treated with rotational atherectomy. Gentle balloon inflation was performed in the mid and proximal RCA (3.0-mm compliant balloon to 4 atmospheres). A gentle puff of contrast after the balloon inflation showed propagation of the dissection proximally back to the right coronary sinus and ascending aorta. A 3.5ϫ23 mm Xience stent (Abbott Vascular, Abbott Park, Ill) was immediately deployed to the RCA ostium to seal the entry site of the dissection ( Figure 1B). There was no hemodynamic compromise or any evidence of aortic regurgitation. The rest of the RCA was stented with multiple Xience stents and postdilated with excellent final angiographic result ( Figure 1C). At angiography, the aortic dissection seemed to be confined to the sinus of Valsalva. Transthoracic echocardiogram showed ascending aortic dissection without aortic regurgitation or pericardial effusion.

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Section: Discussionmentioning

confidence: 77%

Resolution of Iatrogenic Aortic Dissection Illustrated by Computed Tomography

Garg

Buckley

Rybicki

et al. 2009

Circ: Cardiovascular Interventions

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show abstract

“…Recent studies suggest that less invasive studies such as TEE, CT scanning and MRI provide excellent diagnostic accuracy and mitigate some of the risks inherent to retrograde angiography (Table 2). [7][8][9][10][11][12][13][14][15][16][17][18][19] Unfortunately, the methodology of the research studies supporting the use of these alternative imaging modalities may make their results inappropriate for populations with a relatively low prevalence of aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

“…24 Multi-detector row CT is the most rapid diagnostic test for aortic dissection, with data acquisition accomplished in less than 30 seconds. 18 Reported sensitivities and specificities range from 79% to 100% for CT, but early studies should be interpreted with caution as this technology is evolving rapidly. 7,11,12,15,16,18 Combining colour Doppler transthoracic echocardiography (TTE) with CT increases diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

The utility of multiple imaging modalities to diagnose acute aortic dissection

Hurley

Ducharme

2008

CJEM

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A 21-year-old man with Marfan syndrome and known aortic root aneurysm presented to our emergency department with symptoms suggestive of acute aortic dissection. The patient was hemodynamically stable and bilateral upper extremity blood pressures were similar. There was no mediastinal widening on portable chest radiograph. Both contrast CT and retrograde angiography of the aorta failed to identify dissection. Subsequent transesophageal echocardiography demonstrated a Stanford classification type A dissection. This case demonstrates the utility of multiple imaging modalities for identifying aortic dissection in high-risk patients. RÉSUMÉUn jeune homme de 21 ans atteint du syndrome de Marfan avec présence connue d'un anévrisme de la racine aortique s'est présenté à l'urgence avec des symptômes évoquant une dissection aiguë de l'aorte. Le patient était stable sur le plan hémodynamique et les pressions artérielles bilatérales des membres supérieurs étaient similaires. Les résultats de la radiographie pulmonaire réalisée sur un appareil portatif n'indiquaient pas d'élargissement du médiastin. Ni la tomodensitométrie avec agent de contraste ni l'angiographie rétrograde de l'aorte n'ont permis de déceler la dissection. Une échocardiographie transoesophagienne subséquente a montré qu'il s'agissait d'une dissection de type A selon la classification de Stanford. Ce cas met en évidence l'utilité d'avoir recours à de multiples techniques d'imagerie médicale pour établir un diagnostic de dissection aortique chez les patients à haut risque.

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“…However, multiple case reports and small series have reported successful implementation of both surgical and medical therapy of cocaine-related aortic dissection. 9,12,20,32,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] We believe that it is reasonable to apply current therapeutic recommendations for patients with aortic dissection unrelated to cocaine use to patients with cocaine-related aortic dissection.…”

Section: Managementmentioning

confidence: 99%

Cocaine and aortic dissection

2010

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Aortic dissection is a rare, potentially catastrophic vascular emergency. Early recognition of the clinical manifestations, rapid confirmation using imaging modalities, urgent administration of appropriate medication and expedient selection of definitive long-term therapy are key to preserving life and reducing morbidity. In recent years it has become increasingly clear that there is a relation between cocaine and aortic dissection. Cocaine serves as both a predisposing factor to aortic dissection due to its effect on aortic connective tissue and as a precipitating factor due to its propensity to produce abrupt and severe hypertension. While similarities exist in the clinical features and diagnostic methods between cocainerelated aortic dissection and aortic dissection unrelated to cocaine use, there are important differences in management between these two syndromes which are rooted in the pharmacology and physiology of cocaine. An understanding of these differences is key to effective early and long-term management of cocaine-related aortic dissection.

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Suspected Aortic Dissection and Other Aortic Disorders: Multi–Detector Row CT in 373 Cases in the Emergency Setting

Abstract: The positivity rate for acute aortic dissection or other acute aortic disorder in 373 cases examined at multi-detector row CT was 18.0%.

Cited by 148 publications

References 43 publications

Resolution of Iatrogenic Aortic Dissection Illustrated by Computed Tomography

Resolution of Iatrogenic Aortic Dissection Illustrated by Computed Tomography

The utility of multiple imaging modalities to diagnose acute aortic dissection

Cocaine and aortic dissection

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