Celiac artery stenosis threshold for stratifying management in spontaneous isolated dissection

To identify specific imaging predictors for risk stratification in spontaneous isolated celiac artery dissection (SICAD).

In this retrospective study, 108 patients with CTA-confirmed SICAD were categorized into Conservative Management (n = 57) and Immediate Intervention (n = 51) groups. Patients under conservative management were further stratified by celiac artery stenosis severity (≤70% vs. > 70%). Multivariate logistic regression was performed to identify independent predictors of failed vascular remodeling. Primary endpoints included complete remodeling and pain relief.

Patients with celiac artery stenosis >70% under conservative management showed significantly lower complete remodeling (16.7% vs. 56.4%, P = 0.012), reduced 3-month false lumen thrombosis (22.2% vs. 66.7%, P = 0.005), and longer hospitalization compared to the ≤70% stenosis subgroup. The intervention group demonstrated superior outcomes in true lumen expansion (60.0% vs. 26.4%, P < 0.001), complete remodeling (70.6% vs. 43.9%, P = 0.013), and shorter hospital stay (3 vs. 6 days, P < 0.001). Stent occlusion occurred in 8% of intervened cases, though all remained asymptomatic. Multivariate analysis identified celiac artery stenosis >70% (adjusted OR = 0.24, 95% CI: 0.06-0.90, P = 0.035), aneurysm formation (adjusted OR = 0.26, 95% CI: 0.07-0.95, P = 0.042), and length of hospital stay (adjusted OR = 0.74, 95% CI: 0.56-0.99, P = 0.042) as independent predictors of poor remodeling.

While conservative management is effective for most SICAD patients, celiac artery true lumen significant stenosis as a critical threshold identifying a high-risk subgroup prone to poor remodeling. Clinicians should also integrate the presence of aneurysm formation and a prolonged hospital stay into their prognostic assessments. For patients with this high-risk profile, early endovascular intervention should be considered.