Learning objectives
Review current classifications ofacute aortic syndromesand their limitations
Highlight the important differentiating features and associated findings that may haveprognostic impact
Provide recommendations for reportingCT-angiogramsto guide appropriate treatment and management
Background
Acute aortic syndromes (AAS) include several distinct clinical entities that present with similar clinical symptoms; thus, highlighting the importance of imaging as an early assessment tool to help differentiate them.
Imaging modalities include contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE). However, the use of CT as the primary imaging modality has increased significantly.
Acute Aortic Syndromes (AAS) can be categorized into 6 different types according to the American College of Cardiology Foundation/American Heart Association.
Aortic dissections (ADs)- true and false...
Conclusion
ADs, LITs, and IMHs are classified using the more popular Stanford classification.However, the Stanford and DeBakey classifications of ADs do not capture the entire spectrum of anatomic variants, such as arch dissections, leading to confusion and potentially inappropriate treatment.
The ACCF/AHA classification system, although more comprehensive, does not easily separated AAS into categories with similar management nor does it require description of morphologic features with prognostic impact.
In CTA reports, we recommend the Stanford classification because of its simplicity of definition and clinical relevance. However...
Personal information and conflict of interest
M. Modares; Toronto/CA - nothing to disclose E. Nguyen; Toronto/CA - nothing to disclose K. Hanneman; Toronto, ON/CA - nothing to disclose J. Chung; Toronto/CA - nothing to disclose M. Ouzounian; Toronto/CA - nothing to disclose
References
Ahn JM, Kim H, Kwon O, et al. Differential clinical features and long-term prognosis of acute aortic syndrome according to disease entity.Eur Heart J. 2019;40:2727-36.
Baliga RR, Nienaber CA, Bossone E, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging. 2014;7:406-424.
Pape LA, Awais M, Woznicki EM, et al. Presentation, diagnosis, and outcomes of acute aortic dissection. JACC. 2015;66:350-8.
Hiratzka LF, Bakris GL, Beckman JA, et al.ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease....