Celiac artery stenosis threshold for stratifying management in spontaneous isolated dissection.

BACKGROUND: To identify specific imaging predictors for risk stratification in spontaneous isolated celiac artery dissection (SICAD). METHODS: In this retrospective study, 108 patients with CTA-confirmed SICAD were categorized into Conservative Management (n = 57) and Immediate Intervention (n = 51) groups. Patients under conservative management were further stratified by celiac artery stenosis severity (≤70% vs. > 70%). Multivariate logistic regression was performed to identify independent predictors of failed vascular remodeling. Primary endpoints included complete remodeling and pain relief. RESULTS: Patients with celiac artery stenosis >70% under conservative management showed significantly lower complete remodeling (16.7% vs. 56.4%, P = 0.012), reduced 3-month false lumen thrombosis (22.2% vs. 66.7%, P = 0.005), and longer hospitalization compared to the ≤70% stenosis subgroup. The intervention group demonstrated superior outcomes in true lumen expansion (60.0% vs. 26.4%, P < 0.001), complete remodeling (70.6% vs. 43.9%, P = 0.013), and shorter hospital stay (3 vs. 6 days, P < 0.001). Stent occlusion occurred in 8% of intervened cases, though all remained asymptomatic. Multivariate analysis identified celiac artery stenosis >70% (adjusted OR = 0.24, 95% CI: 0.06-0.90, P = 0.035), aneurysm formation (adjusted OR = 0.26, 95% CI: 0.07-0.95, P = 0.042), and length of hospital stay (adjusted OR = 0.74, 95% CI: 0.56-0.99, P = 0.042) as independent predictors of poor remodeling. CONCLUSION: While conservative management is effective for most SICAD patients, celiac artery true lumen significant stenosis as a critical threshold identifying a high-risk subgroup prone to poor remodeling. Clinicians should also integrate the presence of aneurysm formation and a prolonged hospital stay into their prognostic assessments. For patients with this high-risk profile, early endovascular intervention should be considered.