Coronary Artery Disease Progression: Insights from Cardiac CT

© 2015, Springer Science+Business Media New York. Coronary plaque progression is a multi-faceted process influenced by cardiovascular risk factors, as well as the presence, extent, stenosis, morphology, and vulnerability of plaque, which may ultimately result in myocardial infarction or death. Traditionally, intravascular ultrasound (IVUS) has been the primary modality to study atherosclerosis progression. However, it is invasive and impractical for screening or monitoring. While coronary artery calcium (CAC) scoring has been widely studied as a non-invasive method to measure plaque progression, it is limited to visualization of stenosis and non-calcified plaque. Coronary computed tomographic angiography (CCTA) allows for visualization of the severity of stenosis, plaque burden, plaque morphology, and ability to differentiate between plaque types. Furthermore, certain CCTA plaque features are useful in identifying vulnerable plaque including low attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. This review covers multiple aspects of plaque progression—its pathophysiology, clinical implications, and use of novel non-invasive technology for the assessment of plaque progression over time.