Does computed tomography angiography for the Adamkiewicz artery add value over standard scanning in thoracic endovascular aortic repair planning?

Objectives: To determine whether Adamkiewicz artery (AKA)-specific computed tomography angiography (CTA) offers additional value for thoracic endovascular aortic repair (TEVAR) planning beyond standard CTA and to identify cases that might benefit from its use, particularly in influencing treatment decisions and assessing spinal cord ischemia (SCI) risk. Methods: We retrospectively reviewed 176 consecutive patients who underwent both standard CTA and AKA-CTA. Patients with >90 days between CTAs and those with reduced-contrast protocols were excluded. Two radiologists assessed the AKA branching levels, and the inter-CTA agreement of AKA findings on standard CTA was measured using AKA-CTA as a reference. We evaluated changes in TEVAR planning and SCI risk scores on the basis of the additional AKA-CTA data and conducted a multivariate logistic analysis to identify predictors of these changes. Results: Among 160 cases (median age 70 years [interquartile range, 58-77]; 110 male patients), the AKA was identified in 95 (59.4%) by standard CTA and in 155 (96.9%) by AKA-CTA. Standard CTA demonstrated 50% concordance with AKA-CTA findings. TEVAR planning was performed in 57 of 80 cases with inconsistent AKA results between CTAs, with adjustments in 18 cases on the basis of AKA-CTA information. Distal landing zone of ≥5 was the only significant predictor of clinical decisions influenced by AKA-CTA (odds ratio, 16; 95% confidence interval, 3.8-111). Conclusions: Although standard CTA identified the AKA with 50% concordance to AKA-CTA findings, AKA-CTA provided valuable insights over standard CTA, particularly in cases with a distal landing zone of ≥5, significantly impacting TEVAR planning and SCI risk assessment.