Noninvasive Imaging of Atherosclerotic Plaque Progression

Abstract

The process of coronary artery disease progression is infrequently visualized. Intravascular ultrasound has been used to gain important insights but is invasive and therefore limited to high risk patients. For low to moderate risk patients, noninvasive methods may be useful to quantitatively monitor plaque progression or regression, and to understand and personalize atherosclerosis therapy. This review discusses the potential for coronary CT angiography (CCTA) to evaluate the extent and subtypes of coronary plaque. CT technology is evolving and image quality of the method approaches the level required for plaque progression monitoring. Methods to quantify plaque on CT angiography are reviewed as well as a discussion of their use in clinical trials. Limitations of CCTA compared to competing modalities include limited evaluation of plaque subcomponents and incomplete knowledge of the value of the method especially in patients with low to moderate cardiovascular risk.

Effect of Eicosapentaenoic and Docosahexaenoic Acids Added to Statin Therapy on Coronary Artery Plaque in Patients With Coronary Artery Disease: A Randomized Clinical Trial

“…Coronary plaque volume was measured by coronary computed tomographic angiography (CCTA). We chose CCTA because it is noninvasive, allows for examination of all coronary arteries in contrast to intravascular ultrasound, which examines only a culprit artery, and has been validated to detect progression of coronary plaque volume 5, 6, 7, 8. Moreover, CCTA has shown attenuation of progression of coronary plaque by statin drugs 9, 10, 11, 12, 13…”

Coronary Atherosclerosis Imaging

“…Non-contrast electrocardiographic (ECG)-gated multidetector CT provides a direct quantitative assessment of coronary artery calcium (CAC) [44]. (Figure 1).…”

How to Utilize Coronary Computed Tomography Angiography in the Treatment of Coronary Artery Disease

“… 24) 25) 26) 27) These non-invasive findings have been validated by invasive IVUS and OCT studies. 1) 26) 27) Moreover, non-contrast coronary calcium CT scan is also useful to evaluate the risk of coronary artery disease using a coronary calcium score and it is well demonstrated to be related to long-term prognosis. 28) …”

“…Unfortunately prediction of such clinically adverse events is difficult by clinical judgement or symptoms alone. 1) 2) 3) Comprehensive approach of coronary atherosclerotic plaque including qualitative and quantitative analysis is necessary for the accurate lesion assessment and treatment planning as well as for the prediction of future outcome ( Fig. 1 ).…”