What is Coronary CT Angiography (CCTA)?
Coronary CT Angiography or CCTA uses a 64-slice scanner to produce detailed pictures of the heart in a few seconds and provide sharp, clear, three-dimensional images. With Coronary CT Angiography, the 64-slice scanner is able to take 192 images of the heart per second. This non-invasive, pain-free procedure offers exceptional image quality, which can mean better diagnosis, faster recovery time and increased patient comfort and convenience.

The 64-slice scanner allows doctors to evaluate the most common causes of acute chest pain with a single scan. It may also permit some patients to avoid surgical procedures, such as cardiac catheterization all together.

How is Coronary CT Angiography performed?
For the patient, it is the same experience as with any clinical CT study where x-ray contrast is injected. Your physician uses a scanner that is able to take 192 images of the heart per second. Once the dye is injected, the actual CT scanning only takes 10 to 15 seconds. The whole procedure, in and out of the scanner, takes approximately 15 to 20 minutes to complete, unless the patient has a high heart rate. The CT technologist and radiologist work closely together when performing these studies. The same routine precautions are taken just as they are with all x-ray studies requiring the injection of a contrast material. All images are sent to a computer for post-processing where three-dimensional renderings of the heart and coronary vessels are created.

What can Coronary CT Angiography show?
Coronary CT Angiography often detects more disease than traditional x-ray angiography alone (which only shows the vessel lumen or "outline"), by also visualizing the soft and calcified plaque by modeling  the coronary vessel walls. For example, Coronary CT Angiography can show early plaque formation, but no luminal narrowing of the vessel; in such a case, there would often (but not always) be no need to do further imaging or testing, as most follow-up cardiac stress testing or traditional angiography would be negative.

For many patients, Coronary CT Angiography may be helpful for an initial, non-invasive look at the coronary vessels. The exam can also be a great compliment to a physical exam and a work-up for heart disease (such as screening for risk factors, blood pressure and cholesterol profile blood tests), especially if the patient has a family history of heart disease, preexisting conditions or elevated cholesterol. A non-invasive coronary CT angiogram is also excellent for cardiac surgeons to follow up patients after coronary artery bypass surgery (CABG), balloon angioplasty or stent replacements.

Some indications for Coronary CT Angiography include:

• Evaluation of chest pain in patients with atypical chest pain and equivocal stress test
• Evaluation of coronary anomalies
• Early detection of atherosclerosis in high-risk patients
• Coronary risk evaluation in patients undergoing major non-cardiac surgery
• Evaluation of thrombolytic therapy in ST-segment elevation acute myocardial infarction
• Evaluation of post-bypass surgery patients
• Evaluation of in-stent restenosis
• Evaluation of lifestyle, dietary or pharmacological interventions on progression/regression of coronary atherosclerosis
• Professional athletes

Patient Preparation
Patients can eat as usual and take all of their medications with one exception - if you are currently taking beta-blockers, please stop this medication on the morning of your test. Since images are clearer at low heart rates, we ask that patients not drink any caffeinated drinks, including coffee, or use tobacco products the morning of or prior to the CT exam. We prefer to see heart rates less than 70 beats per minute (bpm). If the heart rate is over 70 bpm, we cannot guarantee good image quality. Most patients will receive an oral beta-blocker to slow down the heart rate, if the heart rate is elevated (you will receive an IV beta-blocker if you are taking such medications routinely). The oral medication needs to be taken 1 hour before the test to take affect, IV medication may be given immediately before the test. All patients also receives nitroglycerin during the exam which helps produce excellent quality images.

After the exam
It takes approximately 30-40 minutes for the radiologist to process the images. Once this is completed our radiologist (time-permitting) will sit down with you, show the images and discuss the results with the patient. Your primary care doctor and/or cardiologist will also receive a copy of the report and images.