Coronary computed tomography angiography (CTA) allows coronary artery visualization and the detection of coronary stenoses. In addition; it has been suggested as a novel, noninvasive modality for coronary atherosclerotic plaque detection, characterization, and quantification. Emerging data show that coronary CTA-based semiquantitative plaque characterization and quantification are sufficiently reproducible for clinical purposes, and fully quantitative approaches may be appropriate for use in clinical trials. Furthermore, several lines of investigation have validated plaque imaging by coronary CTA against other imaging modalities such as intravascular ultrasound/"virtual histology" and optical coherence tomography, and there are emerging data using biochemical modalities such as near-infrared spectroscopy. Finally, clinical validation in patients with acute coronary syndrome and in the outpatient setting has shown incremental value of CTA-based plaque characterization for the prediction of major cardiovascular events. With recent developments in image acquisition and reconstruction technologies, coronary CTA can be performed with relatively low radiation exposure. With further technological innovation and clinical research, coronary CTA may become an important tool in the quest to identify vulnerable plaques and the at-risk patient.

This is the first validation that standardized, 3-dimensional, quantitative measurements of coronary plaque correlate with IVUS/VH. Mean differences are small, whereas limits of agreement are wide. Low-density noncalcified plaque correlates with necrotic core plus fibrofatty tissue on IVUS/VH.

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Following initiation of a dedicated program with implementation of quality and performance guidelines, complex CTO revascularization may be safely performed with outcomes comparable with reports from established centers. Despite higher resource utilization, CTO revascularization is associated with a positive contribution margin. Requirement of educational and performance standards, mentorship from experts, consensus review for appropriateness and provision of catheterization laboratory policies may represent a model for program development.

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