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Thoracic aortic dissection classification among radiologists and surgeons and management trends

Jaselyn Grant1, Ariel Z Allen2, Leah Traube3

  • 1Albert Einstein College of Medicine, Bronx, NY, USA.

Emergency Radiology
|October 7, 2020
PubMed

Insights

Radiologists and surgeons showed a low discrepancy rate in classifying aortic dissection (AD). Management for type B AD/IMH increasingly favors endovascular approaches, signaling a practice evolution.

Area of Science:

  • Cardiology
  • Radiology
  • Vascular Surgery

Background:

  • Aortic dissection (AD) requires accurate classification for appropriate management.
  • Discrepancies between radiology and surgical interpretations can impact patient care.
  • Understanding current management trends for AD is crucial.

Purpose of the Study:

  • To assess the agreement between radiologists and surgeons in classifying newly diagnosed aortic dissection (AD) using the Stanford classification.
  • To analyze patient management strategies for Stanford type A and type B AD/IMH.

Main Methods:

  • Retrospective review of 3255 CT scans performed for suspected AD.
  • Analysis of radiology reports and electronic health records for AD/IMH diagnosis and Stanford type.
  • Evaluation of surgical versus medical management for different AD types.

Main Results:

  • A low discrepancy rate (1.6%) was observed between radiologists and surgeons in AD classification.
  • Type A AD/IMH was predominantly surgically managed (85%).
  • Type B AD/IMH showed a shift towards endovascular treatment (56% surgical, 95% of which were endovascular).

Conclusions:

  • There is high concordance between radiologists and surgeons in classifying aortic dissection.
  • Endovascular treatment is the predominant approach for type B AD/IMH, indicating a change from historical management.
  • These findings highlight evolving clinical practice in managing aortic dissection subtypes.
Abstract

Keywords:
Aortic dissectionIntramural hematomaStanford classificationType B dissection management

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