From vulnerable plaque to patient: an anatomic and hemodynamic evaluation using coronary computed tomography angiography

Abstract

Coronary artery disease (CAD) is one of the leading causes of death in the Netherlands and worldwide. CAD involves the pathological buildup of plaque within the intimal layer of the epicardial arteries. This process can have long stable intervals, but can abruptly become unstable resulting from acute luminal thrombosis (i.e. acute coronary syndrome of unstable angina, myocardial infarction and sudden coronary death).

Over the past few decades coronary computed tomography angiography (CCTA) has emerged as a guideline-recommend modality to non-invasively diagnose CAD. CCTA can uniquely image the various stages of the atherosclerotic disease process throughout the entire coronary artery tree: ranging from static to dynamic observations, and from subclinical to highly advanced CAD.

This thesis aims to explore a comprehensive anatomic and hemodynamic evaluation of CAD using CCTA. The anatomic imaging approach using CCTA is based on evaluating the adverse intrinsic pathology of plaque, relating to the concept of vulnerable plaque. The hemodynamic imaging approach using CCTA is based on evaluating the extrinsic forces that affect plaques to get rupture-prone, relating to the concept of triggering destabilization.