Cardiac Computed Tomography for Planning Revascularization Procedures
Coronary computed tomography angiography (coronary CTA) is being increasingly used to detect and rule out coronary artery stenoses. Beyond stenosis detection, the abundance of anatomic, morphologic, and physiological information incorporated from a single one-stop-shop CT study has generated considerable interest in the context of preprocedural planning for coronary revascularization. Specifically, preprocedural CTA data sets can assist interventional cardiologists with selective catheter placement, appropriate guidewire choice, accurate stent size selection, and, most importantly, development of a stepwise revascularization strategy plan. This is particularly salient in cases in which noninvasive CTA exceeds the characterization of coronary lesions compared with invasive angiogram and has been successfully used to predict the likelihood of procedural outcome (eg, coronary chronic total occlusions). Unlike invasive angiography, coronary CTA can characterize “adverse” plaque characteristics (eg, low-attenuation plaque) that increase the risk for periprocedural complications and may thus require tailored revascularization strategies. In addition, the procedure itself may be facilitated by projection of 3-dimensional CTA data sets directly to the catheterization laboratory. Finally, the ability of CTA-derived computational fluid dynamics to pinpoint lesion-specific ischemia can be used to predict the functional outcome of coronary revascularization by “virtual stenting” algorithms. Continuous research is clearly needed, but many experienced operators have already integrated CTA into planning and guiding of coronary revascularization.