Noninvasive Functional Characterization of Coronary Plaques by Coronary Computed Tomography – Beyond the Morphology of Vulnerable Plaques

Coronary computed tomography angiography (CCTA) is a reliable screening method of patients with coronary artery disease (CAD). CCTA is capable to assess both coronary stenosis and plaque morphology, but does not provide hemodynamic characterization of the coronary lesions. However, the severity of coronary stenosis does not always reflect the hemodynamic significance of the plaque. Invasive fractional flow reserve (FFR) is considered the gold standard for the functional evaluation of a potential ischemia-causing stenosis. FFR derived from CCTA (FFR-CT) is a new noninvasive diagnostic tool, using a typically acquired CCTA, without the need for any further radiation or medication. Additional functional assessment of the coronary lesions permits a more complex characterization of CAD patients. Based on the FFR-CT examination, patients who need invasive coronary intervention can be selected more precisely, and a more personalized and optimized treatment can be provided.