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Updated: Nov 5, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Utility of ECG-Gated CTA for Detecting and Classifying Coronary Artery Involvement in Patients With Type A Aortic
Gui-Na Ma1,2, Hao Hong2, Osamah Alwalid1,2
1Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Ave, Wuhan 430022, China.
Insights
ECG-gated CT angiography accurately detects coronary artery involvement in type A aortic dissection (TAAD) extending to the sinus of Valsalva. This imaging technique aids in classifying the extent of involvement, guiding surgical planning for improved patient outcomes.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Diagnostic Radiology
Background:
- Type A aortic dissection (TAAD) extending into coronary arteries from the sinus of Valsalva (SV) presents a poor prognosis.
- Management requires tailored surgical repair, such as coronary artery bypass grafting (CABG), based on the extent of coronary involvement.
Purpose of the Study:
- To evaluate the diagnostic performance of ECG-gated aortic computed tomography angiography (CTA) in detecting and classifying coronary artery involvement in TAAD with SV extension.
- To compare CTA findings with surgical outcomes as the reference standard.
Main Methods:
- Retrospective analysis of 112 patients with TAAD and SV involvement who underwent preoperative ECG-gated aortic CTA.
- Independent review of CTA images by two radiologists to identify and classify right (RCA) and left coronary artery (LCA) involvement (Types A, B, C).
- Calculation of diagnostic performance metrics (sensitivity, specificity) and interreader agreement, with surgical findings as the gold standard.
Main Results:
- ECG-gated CTA demonstrated high sensitivity and specificity for detecting various types of RCA and LCA involvement.
- Interreader agreement for classifying coronary involvement was excellent (kappa values 0.85–0.96).
- Surgical interventions correlated with CTA findings, including aortic repair, direct coronary repair, and CABG for Type C involvement.
Conclusions:
- ECG-gated CTA is a highly accurate imaging modality for diagnosing and classifying coronary artery involvement in patients with TAAD involving the SV.
- CTA findings are crucial for guiding presurgical planning and selecting appropriate interventions for these complex cases.
Abstract:
BACKGROUND. Extension of type A aortic dissection (TAAD) from the sinus of Valsalva (SV) into the coronary arteries is associated with a poor prognosis and requires direct coronary repair or coronary artery bypass grafting (CABG) depending on the extent of involvement. OBJECTIVE. The purpose of this study was to assess the diagnostic performance of ECG-gated aortic CTA with surgical findings as the reference for detection and classification of coronary artery involvement in patients with TAAD involving the SV. METHODS. This retrospective study included 112 patients who underwent preoperative ECG-gated aortic CTA that showed TAAD with SV involvement. Two radiologists independently reviewed CTA images for right coronary artery (RCA) and left coronary artery (LCA) involvement. Involvement was classified according to a previously described system as type A (coronary ostial dissection), B (dissection with coronary false channel), or C (complete detachment from aortic root with dissection encircling the coronary artery). The diagnostic performance of CTA was calculated with surgical findings as the reference; interreader agreement was assessed; and surgical interventions were summarized. RESULTS. At surgery, the RCA was uninvolved in 33 patients and had type A involvement in 45, type B involvement in 19, and type C involvement in 15 patients. The LCA was uninvolved in 70 patients and had type A involvement in 34 patients, type B involvement in eight patients, and type C involvement in no patient. For the two readers, sensitivity in making the diagnosis in the RCA was 86.7% and 91.1% for type A, 79.0% and 89.5% for type B, 86.7% and 93.3% for type C, and 97.5% and 98.7% for any involvement. Sensitivity for the LCA was 85.3% and 91.2% for type A, 87.5% and 100% for type B, and 100% for any involvement. Specificity for the RCA was 94.0% and 97.0% for type A, 95.7% and 96.7% for type B, 96.9% and 96.9% for type C, and 93.9% and 97.0% for any involvement. Specificity for the LCA was 96.2% and 98.7% for type A, 96.2% and 97.1% for type B, and 97.1% and 98.6% for any involvement. Interreader agreement for types of involvement ranged from a kappa value of 0.85 to 0.96. The most common interventions were aortic repair for SV involvement alone (55.7-63.6%), coronary artery repair for types A and B involvement (53.3-87.5%), and CABG for type C involvement (86.7%). CONCLUSION. ECG-gated CTA has high diagnostic performance in the detection and classification of coronary involvement in TAAD with SV involvement. CLINICAL IMPACT. CTA findings may help guide presurgical planning for patients with TAAD.
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