Coronary CT Angiography to Guide Percutaneous Coronary Intervention.

Coronary CT angiography (CCTA) has emerged as a powerful noninvasive tool for characterizing the presence, extent, and severity of coronary artery disease (CAD) in patients with stable angina. Recent technological advancements in CT scanner hardware and software have augmented the rich information that can be derived from a single CCTA study. Beyond merely identifying the presence of CAD and assessing stenosis severity, CCTA now allows for the identification and characterization of plaques, lesion length, and fluoroscopic angle optimization, as well as enables the assessment of the physiologic extent of stenosis through CT-derived fractional flow reserve, and may even allow for the prediction of the response to revascularization. These and other features make CCTA capable of not only guiding invasive coronary angiography referral, but also give it the unique ability to help plan coronary intervention. This review summarizes current and future applications of CCTA in procedural planning for percutaneous coronary intervention, provides rationale for wider integration of CCTA in the workflow of the interventional cardiologist, and details how CCTA may help improve patient care and clinical outcomes. Keywords: CT Angiography © RSNA, 2022.
Competing Interests: Disclosures of Conflicts of Interest: G.T. Supported by the Fondation Vaudoise de Cardiologie; short term funding from HeartFlow as an independent CT reader in a clinical research study. G.S.G. British Heart Foundation travel fellowship (FS/TF/21/33008); trainee editorial board member for Radiology: Cardiothoracic Imaging (since December 2021). H.T. Payment for research assistance from HeartFlow. N.M. No relevant relationships. J.S. Supported by a research grant provided by the CardioPath PhD program, University of Naples Federico II. O.M. Research grants from Edwards. J.A.L. Unrestricted research grant from GE Healthcare; stock options and consulting fees from HeartFlow and Circle CVI; speaking fees from GE and Philips, deputy editor for Radiology: Cardiothoracic Imaging. C.C. Grants or contracts from Biosensor, HeartFlow, Siemens, GE, Pie Medical Imaging, Boston Scientific, and Abbott Vascular; consulting fees from Opsens, Insight Lifetech, Boston Scientific, Medyria, Siemens, Pfizer, HeartFlow, and Philips Volcano; participation on a Data Safety Monitoring Board or Advisory Board for Abbott Vascular, Opsens, and Boston Scientific.
(2022 by the Radiological Society of North America, Inc.)