A 55-year-old diabetic male with atypical chest pain undergoes coronary CT angiography (CCTA). The report describes a stenosis with a low-attenuation plaque occupying >50% of the lumen with positive remodelling and a 'napkin-ring' sign. The CT-FFR value is 0.76. What is the appropriate management?

• A Medical therapy only — CT-FFR is not ischaemia-significant
• B Repeat CCTA in 12 months
• C Emergency PTCA
• D Invasive coronary angiography with FFR measurement ✓

Explanation

A CT-FFR ≤0.80 indicates haemodynamically significant ischaemia and warrants referral for invasive coronary angiography with pressure-wire FFR to confirm and guide revascularisation. The napkin-ring sign on CCTA represents a lipid-rich necrotic core surrounded by fibrous tissue and predicts plaque vulnerability. CT-FFR of 0.76 (<0.80 threshold) is ischaemia-significant, making medical therapy alone insufficient. Emergency PTCA is reserved for ACS.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.