Editorial
Evaluating aortic dissection: when is coronary angiography indicated?
| The first 150 words of the full text of this article appear below. |
Transoesophageal echocardiography (TOE), rapid sequence spiral computed tomography with intravenous contrast (CT), and magnetic resonance angiography (MRA) have become increasingly useful in the evaluation and diagnosis of acute dissection of the ascending aorta. These diagnostic modalities are fast, safe, non-invasive, and highly accurate, with sensitivity and specificity approaching 100%.1 And although most surgeons agree that aortography is no longer necessary before surgical intervention for acute aortic dissection, the role of coronary angiography remains controversial.
Cardiac catheterisation in patients with aortic dissection, however, may be technically difficult, time consuming, and potentially risky. Standard femoral or brachial artery cannulation for coronary angiography may not allow access to the true lumen of the aorta. In addition, specific risks of catheterisation include extending the dissection by advancement of the catheter or guidewire, perforation of the aorta by manipulation or injection in the false lumen, or displacement of thrombotic material from a dissected aorta.8
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