CTA Coronary Arteries

  • Background

    • History
    • 2 Parts
      • Calcium Score
      • CTA

  • Principles

    • requires high temporal and spatial resolution

  • Indications

    • Chest pain, shortness of breath or other symptoms of coronary artery disease.
    • Unclear or inconclusive stress test results.
    • A strong family history of early heart disease.
    • Multiple other risk factors for coronary artery disease (hypertension, diabetes, cholesterol abnormality, smoking)
    • Ruling out significant luminal stenoses in stable patients with suspected coronary stenoses, but intermediate pretest likelihood of disease
      • most useful in patients with a low-to-intermediate likelihood of CAS.
    • Suspicion of congenital anomalies
    • patients with left bundle branch block of unknown etiology
    • patients with new onset heart failure
    • ER chest pain neg ecg and enzymes  CTA can be a useful tool to rapidly assess the coronary arteries for the presence of coronary lesions  cost-effectiveness in comparison with standard diagnostic algorithms, 17

  • Contraindication

    • Relative
      •  patient’s heart rate,
      • body weight, or
      • ability to perform a breath-hold,
      • contrast or problems with
      • vascular access (which may make invasive angiography more prone to complication)–

  • Advantages

    • high negative predictive value
    • Provides high-definition 3-D images of the arteries feeding the heart and blockages at the earliest stages when they can be treated most effectively
    • Most accurate noninvasive diagnostic test for coronary artery disease
    • Measures both calcified and noncalcified plaques. Noncalcified plaques are more prone to rupture and cause heart attacks than calcified plaques. By assessing both types of plaque, coronary CTA analyzes your risk for a heart attack.
    • Monitor the effectiveness of therapy since noncalcified plaques may shrink with effective treatment
    • cross-sectional nature permits visualization not only of the contrast-enhanced coronary artery lumen, but also of the vessel wall (if image quality is adequate). In this way, atherosclerotic plaque can become visible, which is undetectable in the invasive coronary angiogram

  • Disadavantages

    •  Limited temporal resolution can reduce image quality, especially if heart rates are above 60 beats per minute (bpm)
    • Since data acquired over several heartbeats are necessary to acquire a complete data set, coronary CTA is not reliably possible in patients with arrhythmias (scanner design concepts with ≥256 slices may help overcome this limitation).
    • analysis was limited to segments of ≥1.5 mm in diameter.
    • Also, there is a tendency to overestimate the degree of stenosis in CT as compared with the invasive angiogram,
    • extensive calcifications can render image interpretation impossible.
    • In patients with a very low pretest likelihood, the false-positive rate may be too high,
    • patients with a very high pretest likelihood, sensitivity may not be sufficiently high.
      • patients with a high pretest likelihood of disease, performing an invasive, catheter-based coronary angiogram will often be much more appropriate because it offers the option of immediate treatment.

  • Aim

  • Method

    • Patient Preparation
    • Equipment
      • 64-slice CT has made coronary CT angiography (CTA) a relatively robust and stable tool for coronary artery visualization
    • Technique
      •  The test is done in a single breath-hold while the patient lies on a CT scanner bed.

  • Results

  • Potential Complications

TCV

See CTA Lecture

References and Links

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