Coronary Artery Disease Progression: Insights from Cardiac CT

Plaque progression is a multi-faceted process characterized by the incidence, extent, stenosis, burden, morphology, and vulnerability of plaque, which may ultimately result in myocardial infarction or death. For years, intravenous ultrasound (IVUS) has been the primary modality to study progression. However, it is invasive and impractical for screening or monitoring. While coronary artery calcium scoring (CAC) has been widely studied as a non-invasive method to measure plaque progression, it is limited to visualization of stenosis and non-calcified plaque. Coronary computed tomographic angiography (CCTA) allows for visualization of the severity of stenosis, plaque burden, plaque morphology, and ability to differentiate between plaque types. Furthermore, certain CCTA plaque features are useful in identifying vulnerable plaque including low attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. This review covers multiple aspects of plaque progression-its pathophysiology, clinical implications, and use of novel noninvasive technology for the assessment of plaque progression over time. Key words; Coronary artery disease, Plaque progression, Coronary computed tomographic angiography