Computed tomographic angiography in coronary artery disease
Patrick W. Serruys, Nozomi Kotoku, Bjarne Linde Nørgaard, Scot Garg, Koen Nieman, Marc R. Dweck, Jeroen J. Bax, Juhani Knuuti, Jagat Narula, Divaka Perera, Charles A. Taylor, Jonathon Leipsic, Edward Nicol, Nicolò Piazza, Carl Schultz, Kakuya Kitagawa, Bernard De Bruyne, Carlos Collet, Kaoru Tanaka, Saima Mushtaq, Marta Belmonte, Darius Dudek, Adriana Złahoda-Huzior, Shengxian Tu, William Wijns, Faisal Sharif, Matthew J. Budoff, Johan De Mey, Daniele Andreini, Yoshinobu Onuma
Abstract
Coronary computed tomographic angiography (CCTA) is becoming the first-line investigation for establishing the presence of coronary artery disease and, with fractional flow reserve (FFR CT ), its haemodynamic significance. In patients without significant epicardial obstruction, its role is either to rule out atherosclerosis or to detect subclinical plaque that should be monitored for plaque progression/regression following prevention therapy and provide risk classification. Ischaemic non-obstructive coronary arteries are also expected to be assessed by non-invasive imaging, including CCTA. In patients with significant epicardial obstruction, CCTA can assist in planning revascularisation by determining the disease complexity, vessel size, lesion length and tissue composition of the atherosclerotic plaque, as well as the best fluoroscopic viewing angle; it may also help in selecting adjunctive percutaneous devices (e.g., rotational atherectomy) and in determining the best landing zone for stents or bypass grafts.