Thoracic aortic dissection classification among radiologists and surgeons and management trends
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ORIGINAL ARTICLE
Thoracic aortic dissection classification among radiologists and surgeons and management trends Jaselyn Grant 1 & Ariel Z. Allen 1 & Leah Traube 2 & Jeffrey M. Levsky 2,3 & Linda B. Haramati 2,3 Received: 8 June 2020 / Accepted: 29 September 2020 # American Society of Emergency Radiology 2020
Abstract Objective To investigate the discrepancy rate in classification of newly diagnosed aortic dissection (AD) between radiologists and surgeons and explore patient management. Methods 3255 CTs performed for AD from June 2013 to June 2018 at our institution were retrospectively identified. CT reports and charts were reviewed to identify newly diagnosed AD or intramural hematoma (IMH). Radiology reports and electronic health records were reviewed for Stanford type A or B classification and surgical versus medical management. Results Newly diagnosed AD was diagnosed in 1.9% (62/3255) with one false positive, mean age 60 years. Discrepancy rate was 1.6% (1/61). Type A AD/IMH was treated surgically in 85% (23/27), medically in 15% (4/27). Type B AD/IMH was treated surgically in 56% (19/34) (endovascular 95% (18/19)), medically in 44% (15/34). Conclusions Discrepancy rate between radiologists and surgeons in Stanford classification of aortic dissection was low. Management of type B AD/IMH was predominantly endovascular, reflecting a shift in practice from the historical binary management strategy of type A dissections being treated surgically and type B dissections medically. Keywords Aortic dissection . Intramural hematoma . Stanford classification . Type B dissection management
Introduction Aortic dissection (AD) comprises a devastating spectrum of disease, carrying an overall mortality rate for those who reach the emergency department of greater than 27% [1]. Early diagnosis and management are of paramount importance, as the greatest risk of death is within the first few hours of symptom onset [2]. The diagnosis and management of aortic dissection and intramural hematoma (IMH) involves an interdisciplinary approach with input from emergency medicine, radiology, cardiology, cardiothoracic surgery, and vascular surgery. Due to
* Ariel Z. Allen [email protected] 1
Albert Einstein College of Medicine, Bronx, NY, USA
2
Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
3
Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
the acuity, complexity, and requirement for rapid management, the interdisciplinary team must coordinate seamlessly. The Stanford system, proposed in 1970, is currently used to classify aortic dissection [3]. It was created to be a basic binary system that guides management, in which type A dissections, involving the ascending aorta, undergo surgery and type B dissections, which spare the ascending aorta, receive medical treatment [4]. IMH is similarly classified using the Stanford system [2, 5–7]. While the Stanford system has been widely used across disciplines for decades, its binary nature does not account for the current complexity of disse
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