Emergency Radiology

, Volume 17, Issue 3, pp 185–190 | Cite as

Computed tomographic coronary angiography in patients with surgically treated type A aortic dissection: preliminary results

  • Andrea B. Rosskopf
  • Rahel Bugmann
  • Volkhard GoeberEmail author
  • Daniel Ott
  • Otto Hess
  • Thierry Carrel
  • Hanno Hoppe
Original Article


Acute type A aortic dissection is a serious emergency with a mortality rate of up to 40% within the first 24 h when left untreated. Surgical therapy needs to be initiated promptly. Due to this urgent situation, preoperative evaluation of the coronary arteries is not routinely performed in these patients. The aim of this study was to evaluate the accuracy of 64-slice computed tomography angiography (CTA) for postoperative coronary artery assessment in these patients. Ten consecutive patients with two or more cardiovascular risk factors were prospectively enrolled. Patients had type A aortic dissection treated surgically with a supracoronary graft of the ascending aorta. Performance of CTA to exclude significant stenosis (>50% lumen narrowing) and/or coronary artery dissection was compared with quantitative coronary angiography. A total of 147 segments were evaluated. Three segments (2%) were excluded from analysis. CTA correctly assessed one of three significant stenoses in three patients and correctly excluded coronary artery disease (CAD) in six of ten patients. One patient was rated false positive. Overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT for identifying coronary artery disease by segment was 98%, 33%, 99%, 50%, and 99%, respectively (P < 0.05). By patient, it was 70%, 33%, 86%, 50%, and 75%, respectively. No coronary artery dissection was found. Noninvasive CTA may be a viable alternative to conventional angiography for postoperative coronary artery evaluation in patients with surgically treated type A aortic dissection and cardiovascular risk factors. An NPV of 99% should allow for reliable exclusion of CAD. Further studies with higher patient numbers are warranted.


Aortic dissection Cardiac CT CTA 


  1. 1.
    Anagnostopoulos CE, Prabhakar MJ, Kittle CF (1972) Aortic dissections and dissecting aneurysms. Am J Cardiol 30:263–273CrossRefPubMedGoogle Scholar
  2. 2.
    Motallebzadeh R, Batas D, Valencia O, Chandrasekaran V, Smith J, Brecker S et al (2004) The role of coronary angiography in acute type A aortic dissection. Eur J Cardiothorac Surg 25:231–235CrossRefPubMedGoogle Scholar
  3. 3.
    Muhlenbruch G, Seyfarth T, Soo CS, Pregalathan N, Mahnken AH (2007) Diagnostic value of 64-slice multi-detector row cardiac CTA in symptomatic patients. Eur Radiol 17:603–609CrossRefPubMedGoogle Scholar
  4. 4.
    Leber AW, Knez A, von Ziegler F, Becker A, Nikolaou K, Paul S et al (2005) Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 46:147–154CrossRefPubMedGoogle Scholar
  5. 5.
    Ghostine S, Caussin C, Habis M, Habib Y, Clement C, Sigal-Cinqualbre A et al (2008) Non-invasive diagnosis of ischaemic heart failure using 64-slice computed tomography. Eur Heart J. 29:2133–2140CrossRefGoogle Scholar
  6. 6.
    Mowatt G, Cook JA, Hillis GS, Walker S, Fraser C, Jia X et al (2008) 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis. Heart 94:1386–1393CrossRefPubMedGoogle Scholar
  7. 7.
    Flohr TG, Stierstorfer K, Ulzheimer S, Bruder H, Primak AN, McCollough CH (2005) Image reconstruction and image quality evaluation for a 64-slice CT scanner with z-flying focal spot. Med Phys 32:2536–2547CrossRefPubMedGoogle Scholar
  8. 8.
    Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS et al (1975) A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 51(4 Suppl):5–40PubMedGoogle Scholar
  9. 9.
    Larson EW, Edwards WD (1984) Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol 53:849–855CrossRefPubMedGoogle Scholar
  10. 10.
    Ballal RS, Nanda NC, Gatewood R, D’Arcy B, Samdarshi TE, Holman WL et al (1991) Usefulness of transesophageal echocardiography in assessment of aortic dissection. Circulation 84:1903–1914PubMedGoogle Scholar
  11. 11.
    Hart WL, Berman EJ, La CR (1963) Hazard of retrograde aortography in dissecting aneurysm. Circulation 27:1140–1142PubMedGoogle Scholar
  12. 12.
    Kern MJ, Serota H, Callicoat P, Deligonul U, Lee WH, Aguirre F et al (1990) Use of coronary arteriography in the preoperative management of patients undergoing urgent repair of the thoracic aorta. Am Heart J 119:143–148CrossRefPubMedGoogle Scholar
  13. 13.
    Penn MS, Smedira N, Lytle B, Brener SJ (2000) Does coronary angiography before emergency aortic surgery affect in-hospital mortality? J Am Coll Cardiol 35:889–894CrossRefPubMedGoogle Scholar
  14. 14.
    Creswell LL, Kouchoukos NT, Cox JL, Rosenbloom M (1995) Coronary artery disease in patients with type A aortic dissection. Ann Thorac Surg 59:585–590CrossRefPubMedGoogle Scholar
  15. 15.
    Scanlon PJ, Faxon DP, Audet AM, Carabello B, Dehmer GJ, Eagle KA et al (1999) ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol 33:1756–1824CrossRefPubMedGoogle Scholar
  16. 16.
    Rizzo RJ, Aranki SF, Aklog L, Couper GS, Adams DH, Collins JJ Jr et al (1994) Rapid noninvasive diagnosis and surgical repair of acute ascending aortic dissection. Improved survival with less angiography. J Thorac Cardiovasc Surg 108:567–574PubMedGoogle Scholar
  17. 17.
    Achenbach S, Anders K, Kalender WA (2008) Dual-source cardiac computed tomography: image quality and dose considerations. Eur Radiol 18:1188–1198CrossRefPubMedGoogle Scholar
  18. 18.
    Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, Decramer I, Van Hoe LR, Wijns W et al (2007) Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology 244:419–428CrossRefPubMedGoogle Scholar
  19. 19.
    Sun Z, Jiang W (2006) Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta-analysis. Eur J Radiol 60:279–286CrossRefPubMedGoogle Scholar
  20. 20.
    Frauenfelder T, Appenzeller P, Karlo C, Scheffel H, Desbiolles L, Stolzmann P et al (2008) Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings. Eur Radiol. 19:789–799CrossRefPubMedGoogle Scholar
  21. 21.
    Schertler T, Scheffel H, Frauenfelder T, Desbiolles L, Leschka S, Stolzmann P et al (2007) Dual-source computed tomography in patients with acute chest pain: feasibility and image quality. Eur Radiol 17:3179–3188CrossRefPubMedGoogle Scholar
  22. 22.
    Stolzmann P, Leschka S, Scheffel H, Krauss T, Desbiolles L, Plass A et al (2008) Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with low radiation dose. Radiology 249:71–80CrossRefPubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2009

Authors and Affiliations

  • Andrea B. Rosskopf
    • 1
  • Rahel Bugmann
    • 1
  • Volkhard Goeber
    • 2
    Email author
  • Daniel Ott
    • 1
  • Otto Hess
    • 3
  • Thierry Carrel
    • 2
  • Hanno Hoppe
    • 1
  1. 1.RadiologyBern University HospitalBernSwitzerland
  2. 2.Department of Cardiac SurgeryBern University Hospital (Inselspital)BernSwitzerland
  3. 3.CardiologyBern University HospitalBernSwitzerland

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