A review article published in Radiology: Cardiothoracic Imaging suggests that coronary CT angiography (CCTA) may have an important role in planning and guiding coronary interventions. Clinicians from multiple sites in Europe, Japan and Canada provide the rationale for broader integration of CCTA within interventional cardiology workflow.
CCTA can provide complementary information to invasive coronary angiography regarding plaque composition and volume that may impact the intervention. Specifically, CCTA provides information on plaque characteristics, luminal dimensions and lesion length; enables an accurate assessment of bifurcation lesion dimensions and plaque distribution relative to the carina; and allows for identification of coronary plaque features that may indicate a patient is at higher risk for peri- or postprocedural coronary events. Further, using CCTA to evaluate a lesion’s calcium, arc, length and thickness may help interventionalists determine whether to consider lesion preparation to fracture the calcium to facilitate stent expansion. Underexpansion of the stent is often the cause of stent failure.
The emergence of CT-derived fractional flow reserve (FFRCT), which provides a physiologic assessment of coronary artery disease (CAD), may be useful in the clinical decision-making for myocardial revascularization. The authors suggest that including FFRCT in the workup of patients with suspected CAD could improve patient selection.
In chronic total occlusions, CCTA can identify and quantitatively evaluate structure of atherosclerotic plaque and provide detailed anatomic information of the entire coronary vasculature and can therefore be used for planning and periprocedural guidance. For coronary artery bypass graft (CABG) procedures, CCTA should be considered for graft assessment especially in patients with symptoms of ongoing ischemia and those with recurrent chest pains.
The authors also explore the use of CCTA for coronary artery fistulas and coronary aneurysms for accurate anatomic assessments and to provide a roadmap. They conclude that “The opportunity to use CCTA technologies and advanced analytics is enabling the transition of CCTA from strictly being used for diagnosis to a tool that can be used to plan coronary interventions.”Back To Top
CCTA may be Ideal for Planning, Guiding Coronary Interventions. Appl Radiol.