Cardiac computed tomography for planning and guidance of coronary revascularization: An expert position of the Association of Cardiovascular Interventions of the Polish Cardiac Society

Abstract

Coronary computed tomography angiography (CCTA) is a guideline-recommended imaging modality for detecting coronary artery stenoses and risk stratification in patients with low-to-intermediate pretest likelihood of coronary artery disease (CAD). Significantly, the steady advances in CT technology, extending its wider adoption to more challenging patient populations, coincided with new data from clinical trials supporting the role of CCTA for preprocedural planning and periprocedural guidance of coronary interventions. The abundance of anatomic, morphological, and physiological information incorporated from CCTA is uniquely suited to streamlining CAD diagnosis and treatment. Specifically, the additive value of CCTA over invasive angiography can be characterized as follows: 1) detailed evaluation of plaque volume and composition including detection of high-risk plaques; 2) improved referrals to coronary revascularization (including the preferred mode of intervention) by means of CCTA-derived fractional flow reserve and/or CT myocardial perfusion imaging; 3) preprocedural planning and periprocedural guidance in complex CAD (including chronic total occlusions, bifurcations, calcified lesions, bypass grafts); 4) selection of stent size based on anatomic (qualitative CT plaque analysis) and physiological (CT-fractional flow reserve virtual stenting algorithms) information; and 5) identification of the coronary sites suitable for surgical anastomosis. The aim of the current expert consensus document is to highlight the key advantages of CCTA in the planning and intraprocedural guidance of coronary revascularization interventions, and to provide specific recommendations regarding its practical use by interventional cardiologists.

Keywords: coronary artery disease; coronary computed tomography angiography; coronary revascularization; percutaneous coronary intervention.