Key result
Symptomatic spontaneous isolated celiac artery dissection is linked to ~85% prevalence of type IIb-IV morphology.
Why the study?
The natural course and optimal management of spontaneous isolated celiac artery dissection (SICAD) according to morphologic classification on CTA were unclear.
What is the natural course and association between symptoms and morphological classification in patients with spontaneous isolated celiac artery dissection?
Observational (n=21)
What is the natural course and association between symptoms and morphological classification in patients with spontaneous isolated celiac artery dissection?
Absolute Event Rate: 84.6% vs 12.5%
p-value: p=.002
Conservative management is generally appropriate for stable patients with spontaneous isolated celiac artery dissection, though specific morphological types and smaller true lumen diameters are associated with symptoms.
May inform symptom risk stratification by morphology in spontaneous isolated celiac artery dissection; leaves open prospective validation before practice change.
We aimed to identify natural course and optimal management of spontaneous isolated celiac artery dissection (SICAD) according to morphologic classification determined on computed tomography angiography (CTA), and to investigate the association between symptoms and morphological classification of SICAD.This retrospective observational study included 21 consecutive patients with SICAD from January 2012 to April 2017. Demographic data, clinical features, treatment modalities, follow-up results, and CTA findings including morphologic classification, dissection length, and relative diameter of the true lumen (TLRD) were reviewed. Changes in follow-up CTA were recorded and compared to prior studies to reveal natural course of the disease.The serial changes of SICAD on follow-up CTA according to morphologic classifications were as follows; type I (5/5, no interval change), type IIa (1/1, no interval change), type IIb (1/1, partial remodeling), type IIIa (1/4, complete remodeling; 1/4, partial remodeling; 1/4, no interval change; 1/4, deterioration), type IIIb (4/6, no interval change; 2/6, partial remodeling), and type IV (2/2, no interval change). Thirteen (61.9%) symptomatic and 8 (38.1%) asymptomatic patients were all treated with conservative management with or without antiplatelet and/or anticoagulation therapies. Symptomatic group (SG) more commonly had type IIb, IIIa, IIIb, and IV than asymptomatic group (AG) (SG; 11 patients, AG; 1 patient, P = .002). TLRD in AG was larger than that in SG (SG: 40.5 ± 24.1%, AG: 61.7 ± 7.0%, P = .045).SICAD might be treated by conservative management in stable patients irrespective of the morphologic classification except for with type IV (dissecting aneurysm) and extension of celiac branch who may need an early intervention. Types IIb, IIIa, IIIb, and IV are TLRD are associated with patients' symptoms. Further studies on extended natural course of SICAD with a larger number of subjects are needed to draw a strong conclusion.
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Kim et al. (2018) conducted an observational in Spontaneous isolated celiac artery dissection (SICAD) (n=21). Symptomatic presentation vs. Asymptomatic presentation was evaluated on Presence of type IIb, IIIa, IIIb, and IV morphology (p=.002). Symptomatic presentation in spontaneous isolated celiac artery dissection was significantly associated with type IIb, IIIa, IIIb, and IV morphology (84.6% vs 12.5%, P=0.002).
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