Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography |
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| Institution: | 1. Centro Cardiologico Monzino, IRCCS, Milan, Italy;2. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy;3. Cardiovascular Center Aalst, OLVZ Aalst, Belgium;4. St Paul''s Hospital & University of British Columbia, Vancouver, British Columbia, Vancouver, Canada;5. Stanford University School of Medicine, Departments of Medicine and Radiology, USA;6. Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil;7. DASA, São Paulo, Brazil;8. Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center, USA;9. Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium;10. Clinical Science Institute, National University of Ireland, Galway, Ireland;11. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy;12. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy;13. Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy;14. Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy;15. Vrije Universiteit Medical Center, Amsterdam, Netherlands;p. Massachusetts General Hospital, Harvard University, Boston, MA, USA |
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| Abstract: | Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD.The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions. |
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| Keywords: | Coronary CT angiography Pre-procedural planning CT-FFR Myocardial CT perfusion Coronary revascularization |
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