Intravascular ultrasound imaging in acute aortic dissection

Abstract

Este estudio evaluó el potencial del ultrasonido intravascular para la detección y delineación de la disección aórtica en 28 pacientes con sospecha de esta condición. Se utilizó un catéter de ultrasonido de 20 MHz, realizando imágenes de la aorta desde la raíz hasta su bifurcación en un promedio de 10 minutos. La disección aórtica fue identificada en 23 pacientes, mientras que en 5 no se detectó. En todos los casos con disección, el ultrasonido intravascular mostró el colgajo íntimo y los lumina verdadero y falso, así como la extensión longitudinal y circunferencial de la disección, la afectación de vasos rama y la presencia de hematoma intramural en la pared aórtica. Además, en casos donde la aortografía no definía claramente la extensión distal, el ultrasonido intravascular lo logró. Los resultados sugieren que esta técnica podría ser útil en la identificación, categorización y descripción de la disección aórtica, siendo un procedimiento rápido, seguro y posible alternativa o complemento diagnóstico.

Objectives: This study was performed to determine the potential of intravascular ultrasound in the detection and delineation of aortic dissection.

Background: Intravascular ultrasound is a new technique capable of displaying real-time cross-sectional images of arterial vasculature. Its clinical use has been explored mostly in coronary and peripheral arterial circulation.

Methods: Intravascular ultrasound imaging of the aorta was performed using a 20-MHz ultrasound catheter in 28 patients with suspected aortic dissection. All patients underwent contrast angiography; 7 had computed tomography; and 22 had transesophageal echocardiography.

Results: Imaging of the aorta from the root level to its bifurcation was performed in all patients in an average of 10 min. No complications occurred. Dissection was present in 23 patients and absent in 5. In the patients without dissection, intravascular ultrasound revealed normal aortic anatomy. In all 23 patients with dissection, intravascular ultrasound demonstrated the intimal flap and true and false lumena. The longitudinal and circumferential extent of aortic dissection, contents of the false lumen, involvement of branch vessels and the presence of intramural hematoma in the aortic wall could also be identified. In cases where aortography could not define the distal extent of the dissection, intravascular ultrasound did.

Conclusions: Our experience in this series of patients with aortic dissection indicates that intravascular ultrasound could be valuable in the identification and categorization of aortic dissection and in the description of associated pathologic changes that may be clinically important. It can be performed rapidly and safely and could serve as an alternative or adjunct diagnostic procedure in patients with aortic dissection.