Transluminal Attenuation Gradient for the Noninvasive Assessment of Functional Significance in Coronary Artery Stenoses

Invasive and noninvasive methods currently used for imaging-based evaluation of the coronary tree reveal a high number of moderate degree coronary artery stenoses, and the decision to revascularize or not such lesions could be difficult in different clinical settings. Therefore, the need for evaluating the functional significance of such lesions appeared obvious and led to the introduction of fractional flow reserve methodology, a new tool proposed for the evaluation of the functional impact of a coronary stenosis. At the same time, new tools have been proposed for the same application, such as the transluminal attenuation gradient along a coronary artery stenosis, determined using cardiac computed angiography. The aim of this short update is to summarize the recent advances in the field of invasive and noninvasive evaluation of the functional significance of coronary artery stenoses

High-Risk Coronary Plaques Complicated with Acute Coronary Syndrome in Young Patients

Coronary computed tomography angiography (CCTA) has evolved notably over the last decade, gaining an increased amount of temporo-spatial resolution in combination with decreased radiation exposure. The importance of CCTA is emerging especially in vulnerable and young patients who might not have developed a viable collateral vascular network to sustain the circulation to an infarction area during a major adverse coronary event. There are a few well-known markers by which a vulnerable plaque can be assessed and that can predict the subsequent events of sudden myocardial ischemia, such as an increased positive remodeling index (cut-off >1.4), low-attenuation plaque (cut-off 0.7), and napkin-ring sign (NRS). This manuscript presents a series of 3 clinical cases of young patients experiencing symptoms and signs of myocardial ischemia who underwent CCTA in order to assess the composition and functional characteristics of atherosclerotic plaques and their repercussion in developing an acute coronary syndrome

Correlations Between the Contrast Density Gradient along the Coronary Stents and Functional Significance of In-stent Restenosis

Introduction: Coronary artery disease (CAD) is the leading cause of death worldwide and is associated with a significant socio-economic impact. In many cases, patients are treated with implanted coronary stents that carry a significant risk for reobstruction. The aim of our study was to evaluate the importance of coronary computed tomography angiography (CCTA) in evaluating the significance of in-stent restenosis lesions and for establishing the indication for reintervention in these cases

CT Determination of Fractional Flow Reserve in Coronary Lesions

Invasively determined fractional flow reserve (FFR) represents the gold-standard method for the functional evaluation of coronary lesions. Coronary computed tomography angiography (CCTA) provides characterization of the coronary anatomy, with important morphological information on the atherosclerotic plaques, but does not offer a hemodynamic evaluation of coronary artery lesions. CT evaluation of FFR (FFRCT) is a new noninvasive diagnostic method, which provides anatomical and functional assessment of the whole coronary tree, based on computational techniques, with no more radiation or hyperemic agent administration compared with routine CCTA. Recent studies demonstrated the safety and accuracy of FFRCT and its therapeutic use and cost benefits in real-world clinical use