Work

A single-session CT angiography protocol for extracoronary vascular abnormality screening in spontaneous coronary artery dissection (SCAD)

Year: 2025

Type: article

Abstract: Introduction: Extracoronary vascular abnormalities (EVAs) are common in patients with spontaneous coronary artery dissection (SCAD), and expert consensus statements recommend evaluation with head-to-pelvis cross-sectional imaging. Lack of a universal imaging protocol remains a barrier to consistent implementation of this recommendation. We sought to implement a high-fidelity, single-session, head-to-pelvis computed tomography angiography (CTA) protocol that minimizes radiation and contrast exposure compared to multisession CTA. Methods: A total of 97 consecutive patients with SCAD were evaluated with a single-session CTA (SS-CTA protocol). The comparison group consisted of 63 consecutive patients who underwent asynchronous CTA of different body segments (MS-CTA). The primary outcome was total radiation dose and contrast volume in each imaging protocol. The secondary outcome was prevalence of EVAs. Results: There was no difference in baseline characteristics, SCAD presentation, or management between groups. The SS-CTA protocol had a 24% lower radiation dose (1873 ± 676 mGy-cm vs 2452 ± 1099 mGy-cm, p < 0.001) and a 21% lower contrast volume (161.2 ± 48.7 mL vs 203.8 ± 68.4 mL, p < 0.001) compared to the MS-CTA protocol. There was no significant difference in the prevalence of EVAs detected between imaging groups (55.7% vs 57.1%, p = 0.854). Conclusion: This study demonstrates the effectiveness of a single-acquisition CTA protocol for EVA detection in patients with SCAD. The SS-CTA protocol minimized radiation and contrast exposure for a patient population that may require frequent imaging over the lifespan. Further studies are needed to determine whether expanded availability of this protocol would improve adherence to expert consensus recommendations.

Source: Vascular Medicine

DOI: 10.1177/1358863x251383872