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Review
. 2023 Nov 15;12(22):7104.
doi: 10.3390/jcm12227104.

Cardiac Computed Tomography in Monitoring Revascularization

Elisabetta Tonet  1 , Veronica Amantea  1 , Davide Lapolla  1 , Paolo Assabbi  1 , Alberto Boccadoro  1 , Maria Letizia Berloni  1 , Marco Micillo  1 , Federico Marchini  1 , Serena Chiarello  2 , Alberto Cossu  2 , Gianluca Campo  1
Affiliations
Review

Cardiac Computed Tomography in Monitoring Revascularization

Elisabetta Tonet et al. J Clin Med. .

Abstract

The use of coronary computed tomography angiography (CCTA) in the setting of stable coronary artery disease is highly recommended for low-risk patients. High-risk patients, such as symptomatic subjects with prior revascularization, are suggested to be investigated with noninvasive functional tests or invasive coronary angiography. CCTA is not considered for these patients because of some well-known CCTA artifacts, such as blooming and motion artifacts. However, new technology has allowed us to obtain images with high spatial resolution, overcoming these well-known limitations of CCTA. Furthermore, the introduction of CT-derived fractional flow reserve and stress CT perfusion has made CCTA a comprehensive examination, including anatomical and functional assessments of coronary plaques. Additionally, CCTA allows for plaque characterization, which has become a cornerstone for the optimization of medical therapy, which is not possible with functional tests. Recent evidence has suggested that CCTA could be used with the aim of monitoring revascularization, both after coronary bypass grafts and percutaneous coronary intervention. With this background information, CCTA can also be considered the exam of choice in subjects with a history of revascularization. The availability of a noninvasive anatomic test for patients with previous coronary revascularization and its possible association with functional assessments in a single exam could play a key role in the follow-up management of these subjects, especially considering the rate of false-positive and negative results of noninvasive functional tests. The present review summarizes the main evidence about CCTA and coronary artery bypass grafts, complex percutaneous coronary intervention, and bioresorbable stent implantation.

Keywords: cardiovascular computed tomography; coronary artery disease; stenting.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CCTA assessment of left main drug-eluting stent (Lumen image on the left, multiplanar reconstruction in the center and on the right). With a new CT scan, beam-hardening artifacts are reduced, and the stent lumen can be assessed with good performance.
Figure 2
Figure 2
ISR in a stent previously implanted in the proximal segment of the left circumflex artery.
Figure 3
Figure 3
CCTA assessment of BRS. Orange brackets highlight the two markers of BRSs whose struts result in complete reabsorption. The vessel is also well analyzed in the scaffolded segment.
Figure 4
Figure 4
Anatomical and functional assessment of ISR in a scaffold (orange bracket). ISR appears to be characterized by a major calcific part, and the stenosis results were significant under the FFR-CT assessment. FFR-CT was performed with DeepVessel FFR (DVFFR) software (Keya Medical, Seattle, WA, USA).
Figure 5
Figure 5
In (A,B), two multiplanar reconstructed images of the left internal mammary artery CABG on the left anterior descending coronary artery. There are no signs of degenerative disease with the patency of grafts.
Figure 6
Figure 6
An occluded saphenous vein graft to the right coronary artery. The graft was previously treated with a stent, which appears occluded.
See this image and copyright information in PMC

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