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Computed Tomography Angiography Identified High-Risk Coronary Plaques: From Diagnosis to Prognosis and Future
Kyriakos Dimitriadis1, Nikolaos Pyrpyris1, Panagiotis Theofilis1
1First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Insights
CT angiography identifies high-risk coronary artery disease (CAD) plaques using specific characteristics. This review covers diagnostic algorithms, plaque vulnerability, and therapeutic implications for preventing ischemic events.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) diagnosis increasingly relies on CT angiography.
- Advancements enable detailed lesion characterization beyond mere obstruction.
Purpose of the Study:
- Review diagnostic algorithms for plaque vulnerability in CT angiography.
- Analyze prognostic factors and therapeutic implications of high-risk plaques.
- Explore CT angiography's role in patient stratification and intervention decisions.
Main Methods:
- Comprehensive literature review of CT angiography in CAD.
- Analysis of plaque characteristics indicative of vulnerability.
- Comparison with invasive imaging modalities.
- Evaluation of prognostic factors and therapeutic strategies.
Main Results:
- CT angiography identifies specific high-risk plaque characteristics.
- These characteristics have prognostic and therapeutic implications.
- Evidence supports intervention in high-risk plaques, even non-flow-limiting ones.
Conclusions:
- CT angiography is crucial for evaluating plaque vulnerability in CAD.
- Understanding plaque characteristics guides treatment decisions and risk stratification.
- Future research may expand interventions for non-flow-limiting high-risk plaques.
Abstract:
CT angiography has become, in recent years, a main evaluating modality for patients with coronary artery disease (CAD). Recent advancements in the field have allowed us to identity not only the presence of obstructive disease but also the characteristics of identified lesions. High-risk coronary atherosclerotic plaques are identified in CT angiographies via a number of specific characteristics and may provide prognostic and therapeutic implications, aiming to prevent future ischemic events via optimizing medical treatment or providing coronary interventions. In light of new evidence evaluating the safety and efficacy of intervening in high-risk plaques, even in non-flow-limiting disease, we aim to provide a comprehensive review of the diagnostic algorithms and implications of plaque vulnerability in CT angiography, identify any differences with invasive imaging, analyze prognostic factors and potential future therapeutic options in such patients, as well as discuss new frontiers, including intervening in non-flow-limiting stenoses and the role of CT angiography in patient stratification.
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