Abstract
Recent technological advances, together with an increasing body of evidence from randomized trials, have placed coronary computer tomography angiography (CCTA) in the center of the diagnostic workup of patients with coronary artery disease. The method was proven reliable in the diagnosis of relevant coronary artery stenosis. Furthermore, it can identify different stages of the atherosclerotic process, including early atherosclerotic changes of the coronary vessel wall, a quality not met by other non-invasive tests. In addition, newer computational software can measure the hemodynamic relevance (fractional flow reserve) of a certain stenosis. In addition, if required, information related to cardiac and valvular function can be provided with specific protocols. Importantly, recent trials have highlighted the prognostic relevance of CCTA in patients with coronary artery disease, which helped establishing CCTA as the first-line method for the diagnostic work-up of such patients in current guidelines. All this can be gathered in one relatively fast examination with minimal discomfort for the patient and, with newer machines, with very low radiation exposure. Herein, we provide an overview of the current technical aspects, indications, pitfalls, and new horizons with CCTA, providing examples from our own clinical practice.
Highlights
Coronary artery disease (CAD) remains an important cause of morbidity and mortality worldwide [1]
The technological advances seen in the last decades, together with a growing body of research confirming the relevance of this diagnostic method in the clinical routine, have made coronary computer tomography angiography (CCTA) a first-line diagnostic tool for the diagnostic work-up of CAD patients [10]
Major advances were seen in PCI technique in the last decades, coronary artery bypass graft (CABG) surgery still remains the standard of care in advanced multivessel CAD [171]
Summary
Coronary artery disease (CAD) remains an important cause of morbidity and mortality worldwide [1]. The work-up of patients with CCS is complex, beginning with the evaluation of the pre-test probability for CAD and proceeding with the selection of appropriate treatment pathways In this regard, non-invasive stress imaging tests were shown to be excellent tools for properly selecting patients who would further benefit from an invasive procedure, providing both precise diagnostic classification and risk stratification [3,4]. In the era of the ORBITA and ISCHEMIA trials, the optimal therapeutic approach for patients with significant CAD became a subject of debate, and in many situations shared decision approaches are recommended [8,9] In this regard CCTA presents itself as an excellent diagnostic tool and as an educational tool for the patient. The relatively “simple” representation of the coronary arteries provides the patient with a clear view and with the help of the physician, an understanding of the underlying anatomical problems
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