Contemporary use of coronary computed tomography angiography in the planning of percutaneous coronary intervention
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REVIEW PAPER
Contemporary use of coronary computed tomography angiography in the planning of percutaneous coronary intervention Breda Hennessey1 · Rafael Vera‑Urquiza1 · Hernán Mejía‑Rentería1 · Nieves Gonzalo1 · Javier Escaned1 Received: 25 September 2020 / Accepted: 29 September 2020 © Springer Nature B.V. 2020
Abstract Planning of percutaneous coronary interventions (PCI) is largely based on anatomical information obtained with invasive coronary angiography. Over the last decade, intracoronary information obtained from both imaging and physiological techniques has gradually gained recognition for this purpose. Yet, coronary computed tomography angiography (CCTA) is still ignored by most interventionalists as a tool in the planning of PCI strategies. This has occurred despite major developments in CCTA, including physiological assessment, plaque characterisation, etc. Furthermore, it is foreseeable that many more patients referred to the catheterisation laboratory will have had a prior CCTA study. In this review we discuss the distinct advantages provided by CCTA in studying coronary artery structure and function. We revisit the most frequent scenarios of complex PCI and establish analogies between the use of intracoronary diagnostics and CCTA in setting procedural strategy, and in anticipating specific challenges. Keywords Coronary computed tomography angiography · Percutaneous coronary intervention · Multi-modality imaging · Planning of percutaneous coronary intervention · Non invasive cardiovascular imaging
Introduction Right from the outset, the field of Interventional Cardiology has been a remarkably dynamic one. However, despite radical improvements in both invasive and non-invasive diagnostic and interventional techniques, coronary artery disease still accounts for over half of cardiovascular deaths world-wide; with cardiovascular disease accounting for the leading cause of mortality globally [1]. In a bid to keep pace, the field of Interventional Cardiology has evolved exponentially in the last number of decades. This evolution has been bolstered by an expanding armamentarium of both invasive and non-invasive coronary imaging modalities and coronary physiology techniques. Whilst Invasive coronary angiography remains at the forefront of the evaluation and treatment of coronary artery disease (CAD), it is not without its limitations. In recent years, the use Coronary Computed Tomography angiography (CCTA) has become widespread. This * Javier Escaned [email protected] 1
is undoubtably due, at least in part, to improved scanning capabilities. It’s primary role currently, is in the evaluation and risk stratification of patients presenting with chest pain. Whilst this is perhaps the most common application of this technology, it also serves as an effective adjunct in other areas, such as, plaque assessment, functional assessment of coronary artery stenosis and it has a role in the planning of complex intervention. The aim of our paper is to explore these various applications with a focus on its i
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