Shabbir Asad, Attia Abdelrahman, Weber Nikkole Marie, Alhassan Mustafa, Radike Monika, Lane Conor M, Challa Apurva Bhavana, Wamil Malgorzata
John Radcliffe Hospital, Oxford University Hospitals, OX3 9DU Oxford, UK.
Cardiology Department, Great Western Hospital NHS Trust, SN3 6BB Swindon, UK.
Rev Cardiovasc Med. 2025 May 26;26(5):37379. doi: 10.31083/RCM37379. eCollection 2025 May.
Recent advancements in computed tomography have significantly transformed the clinical application of this technique in diagnosing and managing coronary artery disease (CAD). Computed tomography coronary angiography (CTCA) has emerged as a leading non-invasive imaging modality, often serving as the first-line investigation to exclude obstructive CAD in patients with chronic coronary syndrome. Beyond its utility in diagnosing CAD, CTCA has become instrumental in procedural planning for percutaneous coronary intervention (PCI), particularly in complex cases such as left main stem (LMS) interventions, where peri-procedural risks are elevated. This review highlights the evolving role of CTCA in LMS PCI, underscoring its clinical utility in improving procedural precision and, subsequently, patient outcomes. Recent technological advancements, including detailed multiplanar and three-dimensional (3D) reconstructions, CT-derived fractional flow reserve (CTFFR), and the integration of artificial intelligence (AI) algorithms, have expanded the capabilities of CTCA. These innovations allow for comprehensive anatomical and functional assessments, enabling precise plaque morphology, lesion complexity, and bifurcation anatomy evaluations alongside PCI simulations. By offering detailed insights into coronary vasculature and lesion characteristics, CTCA provides critical information for optimising LMS PCI strategies. This review explores the current applications and future potential of CTCA in guiding LMS PCI, highlighting its role in improving procedural planning, risk assessment, and overall management of this challenging patient population.
计算机断层扫描技术的最新进展显著改变了该技术在冠状动脉疾病（CAD）诊断和管理中的临床应用。计算机断层扫描冠状动脉造影（CTCA）已成为一种领先的非侵入性成像方式，常作为排除慢性冠状动脉综合征患者阻塞性CAD的一线检查方法。除了在诊断CAD方面的作用外，CTCA在经皮冠状动脉介入治疗（PCI）的手术规划中也发挥了重要作用，特别是在左主干（LMS）介入等复杂病例中，此类病例围手术期风险较高。本综述重点介绍了CTCA在LMS PCI中不断演变的作用，强调了其在提高手术精度以及随后改善患者预后方面的临床实用性。包括详细的多平面和三维（3D）重建、CT衍生的血流储备分数（CTFFR）以及人工智能（AI）算法整合在内的最新技术进展，扩展了CTCA的功能。这些创新使得能够进行全面的解剖和功能评估，在PCI模拟的同时能够精确评估斑块形态、病变复杂性和分叉解剖结构。通过提供关于冠状动脉血管系统和病变特征的详细见解，CTCA为优化LMS PCI策略提供了关键信息。本综述探讨了CTCA在指导LMS PCI中的当前应用和未来潜力，强调了其在改善手术规划、风险评估以及对这一具有挑战性患者群体的整体管理方面的作用。
