Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
J Thorac Imaging. 2018 Jan;33(1):35-54. doi: 10.1097/RTI.0000000000000262.
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.
冠状动脉计算机断层扫描血管造影术（冠状动脉 CTA）越来越多地用于检测和排除冠状动脉狭窄。除了检测狭窄外，从一站式 CT 研究中纳入的大量解剖学、形态学和生理学信息也引起了人们对冠状动脉血运重建前规划的极大兴趣。具体来说，术前 CTA 数据集可以帮助介入心脏病学家进行选择性导管放置、选择合适的导丝、准确选择支架尺寸，最重要的是，可以制定逐步血运重建策略计划。在非侵入性 CTA 比侵入性血管造影术更能描述冠状动脉病变的情况下，这一点尤其重要，并且已经成功用于预测手术结果的可能性（例如，冠状动脉慢性完全闭塞）。与侵入性血管造影术不同，冠状动脉 CTA 可以描述“不利”斑块特征（例如，低衰减斑块），这些特征增加了围手术期并发症的风险，因此可能需要量身定制的血运重建策略。此外，该程序本身可以通过将三维 CTA 数据集直接投影到导管实验室来辅助。最后，基于 CTA 的计算流体动力学来确定特定病变的缺血情况的能力可用于通过“虚拟支架”算法来预测冠状动脉血运重建的功能结果。显然，需要持续进行研究，但许多经验丰富的操作者已经将 CTA 整合到冠状动脉血运重建的规划和指导中。
