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Computed tomographic angiography in coronary artery disease

Patrick W Serruys1, Nozomi Kotoku1, Bjarne L Nørgaard2

  • 1Department of Cardiology, University of Galway, Galway, Ireland.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
|April 7, 2023
PubMed

Insights

Coronary computed tomographic angiography (CCTA) is a key tool for diagnosing coronary artery disease and assessing its severity. It helps rule out disease, monitor plaque, and plan revascularization procedures.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Interventional Cardiology

Background:

  • Coronary computed tomographic angiography (CCTA) is increasingly utilized for diagnosing coronary artery disease (CAD).
  • Fractional flow reserve (FFRCT) integrated with CCTA assesses the functional significance of coronary stenoses.
  • Non-invasive imaging, including CCTA, is crucial for evaluating non-obstructive coronary artery disease and guiding risk stratification.

Purpose of the Study:

  • To delineate the comprehensive role of CCTA in the diagnostic and management pathway of coronary artery disease.
  • To highlight CCTA's utility in both obstructive and non-obstructive coronary atherosclerosis.
  • To emphasize CCTA's contribution to pre-procedural planning for revascularization.

Main Methods:

  • Utilizes coronary computed tomographic angiography (CCTA) for anatomical assessment of coronary arteries.
  • Integrates computational fluid dynamics (CFD) for deriving fractional flow reserve (FFRCT) from CCTA data.
  • Employs advanced imaging analysis to characterize plaque composition, lesion length, and vessel dimensions.

Main Results:

  • CCTA effectively rules out significant coronary atherosclerosis.
  • CCTA identifies subclinical atherosclerosis for monitoring plaque progression/regression and risk classification.
  • CCTA provides detailed anatomical information crucial for revascularization planning, including disease complexity and optimal procedural guidance.

Conclusions:

  • CCTA is a pivotal first-line investigation for coronary artery disease assessment.
  • CCTA, combined with FFRCT, offers a comprehensive evaluation of coronary artery haemodynamics and anatomy.
  • CCTA significantly aids in tailoring prevention strategies and planning revascularization interventions.

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