Vulnerable Plaque Characteristics at Coronary Computed Tomography Angiography

Abstract

According to morbidity and mortality indicators, cardiovascular diseases are the leading public health issue in the Republic of Croatia and the European Union. Although mortality rates from ischemic disease have been reduced, Croatia is still categorized among countries with high cardiovascular risk. The guidelines of the European Society of Cardiology from 2020 for acute coronary syndrome (ACS) in patients with low to intermediate risk of coronary atherosclerotic heart disease (CHD) recommend coronary computed tomography angiography (CCTA) as an alternative to invasive coronarography. In most patients with suspicion of CHD, CCTA leads to the diagnosis of non-obstructive diseases, which causes the majority of ACS cases. Multi-slice Computed Tomography scanners of the newest generation employ low doses of radiation and low contrast volume to reliably show the characteristics of vulnerable plaque: (i) positive remodeling, (ii) low attenuation plaque, (iii) spotty calcifi cation, and the (iv) napkin-ring sign. Due to positive remodeling, these plaques are often non-obstructive, and according to the CAD-RADS 2.0 guidelines from 2022 all their characteristics should be specifi cally emphasized in CCTA fi ndings. Based on the assessment of the prognostic value of vulnerable plaque characteristics for adverse cardiac events, CCTA has been shown to be equally valid as other invasive diagnostic methods. Additionally, it was shown to be useful in indicating the optimal medication therapy and monitoring its eff ects. The results of large international randomized trials indicate the direction of the treatment approach for vulnerable plaque.