Computed tomography imaging features in Stanford type-A aortic dissection predict in-hospital rupture

Abstract

Background: Aortic rupture is a leading cause of early mortality in patients with Stanford type A aortic dissection (TAAD). Current risk assessment models lack critical imaging features, which could enhance their accuracy and sensitivity. This study aimed to identify potential imaging-based risk factors for in-hospital aortic rupture in patients with TAAD.

Methods: We conducted a retrospective cross-sectional study of TAAD cases treated medically between January 2020 and May 2021 at Xiamen Cardiovascular Hospital. A total of 45 patients were initially enrolled; however, 14 patients who did not undergo computed tomography angiography (CTA) at Xiamen Cardiovascular Hospital and 1 patient whose quality of image was poor were excluded. We analyzed clinical data, including basic characteristics, clinical presentations, and morphological features derived from CTA and reconstructed images for the remaining 30 patients.

Results: Aortic rupture accounted for 82% (14/17) of in-hospital deaths among conservatively treated patients with TAAD. Patients who experienced rupture demonstrated a significantly higher proportion of dissected false lumen (P=0.04), a longer false lumen arc length (P=0.02), and an increased distance from the sinotubular junction to the origin of the celiac trunk (P=0.02). Single factor logistic regression analysis identified two risk factors: arc length ≥130 mm (odds ratio =5.78; 95% confidence interval: 1.12-29.85; P=0.04) and centerline distance from the sinotubular junction to the origin of the celiac trunk ≥391 mm (odds ratio =11; 95% confidence interval: 2-60.57; P=0.006).

Conclusions: Morphological features observed on computed tomography imaging can serve as valuable predictors for the risk of aortic rupture in patients with TAAD. Incorporating these features into predictive models could improve risk stratification, allowing for earlier surgical intervention in patients at the highest risk of rupture.

Keywords: Stanford type A aortic dissection (TAAD); aortic rupture; imaging features; risk factor.

Figure 1

Flow chart of patient enrollment and exclusion. TAAD, Stanford type A aortic dissection.

Figure 2

Radiological parameters predisposing to in-hospital rupture in patients with Stanford type A aortic dissection. (A) FLL measured on the centerline of the aorta. The red and blue line represent the starting and ending plane respectively of the FL. The green line represents centerline of the aorta. (B) The widest plane (red line) on the longitudinal axis of the aorta was selected and subsequent measurements were made on the cross section of this plane (C). (C) The dotted red line indicates Dmax; the solid red line indicates the arc length of the FL; the orange angle is the radian of the FL. The number of branch arteries involved by the FL. (D) Dissected innominate artery, left common carotid artery, and left subclavian artery. (E) The arrow indicates the intercostal artery arising from FL. Aortic tortuosity quantified by the ATI, the ratio of the centerline (green solid line in F-H) to the straight linear (green dotted line in F-H) distance between 2 endoluminal points. (F) ATI1: ATI between the STJ to the opening of the innominate artery; (G) ATI2: ATI between STJ to the end of the LSA; (H) ATI3: ATI between STJ to the opening of the celiac trunk. ATI, aortic tortuosity index; Dmax, the maximum diameter of the aorta; FL, false lumen; FLL, false lumen length; LSA, left subclavian artery; STJ, sinus tube juncture.