Assistant Professor of Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
Associate Professor of Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
Imaging of the coronary arteries requires high temporal and spatial resolution. Invasive, catheter-based coronary angiography is the clinical standard tool for assessment of the coronary arteries, but it has several shortcomings: First of all, it is an invasive procedure and, as such, is associated with a certain morbidity and mortality, which in most cases is a consequence of the required arterial access. 1 Secondly, some limitations are due to its projectional nature, finally, cardiac catheterization requires elaborate equipment that is not available at every hospital or outpatient setting, dedicated and well-trained staff is necessary, and associated costs are high. Computed tomographic (CT) technology has progressed rapidly over the past several years. Both spatial and temporal resolution have steadily been improved, and the introduction of 64-slice and higher-slice CT has made coronary CT angiography (CTA) a relatively robust and stable tool for coronary artery visualization
In this presentation, clinical applications, the advantages and disadvantages of CTAwill be weighed against those of invasive coronary angiography.
Coronary CTA has numerous clinical applications. Its most prominent role is in the assessment of patients with possible coronary artery stenosis, but a relatively low likelihood of disease, with the aim to rule out coronary stenosis and avoid the need for an invasive coronary angiogram. This includes patients with various clinical scenarios, such as atypical symptoms, unclear electrocardiographic changes or stress test results, patients with new onset of heart failure, and patients before non coronary cardiac surgery. Assessment of coronary anomalies is another strong indication, but much less frequent. Other applications of CT are to provide peri-interventional information, to detect in- stent restenosis, or to provide risk stratification.