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Review
. 2020 Dec;36(12):2305-2317.
doi: 10.1007/s10554-020-01793-w. Epub 2020 Feb 19.

A review of serial coronary computed tomography angiography (CTA) to assess plaque progression and therapeutic effect of anti-atherosclerotic drugs

Jana Taron  1   2 , Saeyun Lee  3 , John Aluru  4 , Udo Hoffmann  5 , Michael T Lu  5
Affiliations
Review

A review of serial coronary computed tomography angiography (CTA) to assess plaque progression and therapeutic effect of anti-atherosclerotic drugs

Jana Taron et al. Int J Cardiovasc Imaging. 2020 Dec.

Abstract

Change in coronary artery plaque on serial catheter intravascular ultrasound (IVUS) is an established technique to monitor the therapeutic effect of drugs on coronary atherosclerosis. Recent advances in coronary computed tomography angiography (CTA) now allow for non-invasive assessment of change in coronary plaque. Because coronary CTA is noninvasive, it enables clinical trials with lower-risk populations, higher retention rates, and lower costs. This review presents an overview of serial coronary CTA as a noninvasive imaging technique to gauge the therapeutic effect of anti-atherosclerotic therapies. Furthermore, it reviews the increasing use of serial CTA as an imaging endpoint in completed and ongoing clinical trials.

Keywords: Anti-atherosclerotic drugs; Coronary artery plaque; Serial computed tomography angiography.

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Conflict of interest statement

Conflict of interest Dr. Lu reported research funding as a co-investigator to MGH from Kowa Company Limited and Medimmune/Astrazeneca and receiving personal fees from PQBypass unrelated to this work. He reports a research grant from the Nvidia Corporation Academic Program. Dr. Hoffmann reported receiving research support on behalf of his institution from Duke University (Abbott), HeartFlow, Kowa Company Limited, and MedImmune/Astrazeneca; and receiving consulting fees from Duke University (NIH), and Recor Medical unrelated to this research. Dr. Taron was funded by the Deutsche Forschungsge-meinschaft (DFG, German Research Foundation) -TA 1438/1–1.

Figures

Fig. 1
Fig. 1
Qualitative and quantitative analysis of coronary CTA. Panels a–c Standard qualitative analysis of coronary CTA data for the presence of obstructive CAD (stenosis ≥ 50%): a 3D volume-rendered image of the coronary tree with potential narrowing in the proximal (arrow) and mid LAD (arrowhead). b multiplanar reformatted long and c short axis images of the proximal LAD area (white arrows) demonstrating luminal narrowing < 50%. This patient would be classified as having non-obstructive CAD unlikely to be hemodynamically significant as a result of routine diagnostic assessment. Panels d, e Advanced quantitative analysis of another patient demonstrating a plaque with high-risk features. d Cross section of a vessel depicting central low attenuation core in red (asterisk) with ring-like peripheral high attenuation in light green (arrow)—the napkin ring sign. e Output of quantitative analysis with derived minimal luminal area, degree of stenosis, remodeling index, plaque burden, noncalcified and low HU volume, and mean plaque attenuation
Fig. 2
Fig. 2
Increasing non-calcified plaque volume in mid right coronary artery (mRCA) in a patient on placebo. Coronary CTA of mRCA (arrow) at baseline a, c and 12 months follow-up b, d in patient with HIV. High-risk morphology features including positive remodeling and low attenuation lipid core developed on follow-up. Multi-planar reformations in short (a, b) and long (c, d) axis
See this image and copyright information in PMC

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