My CCTA-Could be better or worse

[jetman]

I think? but I'm no cardiologist and I don't have a cardiologist (yet).

Got the results from my Primary Care Provider (PCP) ordered Cardio CT Angiogram (CCTA) w/dye contrast and w/Fractional Flow Reserve (FFR). The FFR was NOT done because my stenosis (blockage) is only mild. This was seen 1 yr ago Coronary Artery Calcium (CAC) test done by the same imaging center. A yr ago I received a Agaston score of 33 because of calcium seen at my Left Anterior Descending (LAD) artery.

This CCTA report states the following about my LAD: "Focal eccentric mixed plaque in the proximal LAD with minimal 15-20% focal stenosis". IMO=could be better or worse. I'll provide more internet info on this in my next post.

My LAD diagonal arteries are patent = open & unobstructed = a good thing.

All my other arteries, Left Main artery (LM), Left Circumflex artery (LCX), Right Coronary artery (RCA), show no plaque or hemodynamically significant stenosis (a good thing).
@Pablo
@alarmguy

 

[jetman]

I'm no cardiologist and I don't have a cardiologist (yet).


This CCTA report states the following about my LAD: "Focal eccentric mixed plaque in the proximal LAD with minimal 15-20% focal stenosis". IMO=could be better or worse. I'll provide more internet info on this in my next post.

The internet says:​

Understanding Focal Ectopic Mixed Plaque in Proximal LAD with 15–20% Stenosis​

A focal ectopic mixed plaque in the proximal left anterior descending (LAD) artery means that, on coronary CT angiography (CCTA), there is a localized area of plaque that contains both non-calcified and calcified components. In coronary imaging “proximal” usually means the first major branch. “Mixed” indicates the plaque is not purely calcified or purely soft (non-calcified) — it has both types of material.

The 15–20% stenosis means the narrowing of the artery’s lumen is about 15–20% of its normal diameter. In standard CCTA categories, this falls into the mild stenosis range (25–49% is moderate, ≥70% is severe) blueripple.com. Mild stenosis generally does not significantly limit blood flow at rest or during typical exertion, but plaque presence and composition can still influence long-term risk.

More to come

 

[jetman]

Clinical significance:
Mixed plaque has been shown in CCTA studies to be a stronger predictor of long-term major adverse cardiovascular events (MACE) than coronary artery calcium (CAC) score alone, even in asymptomatic intermediate-risk patients pmc.ncbi.nlm.nih.gov. This is because mixed plaque often represents a more biologically active, unstable form of atherosclerosis.

In the proximal LAD, lesions can supply a large portion of the left ventricle, so even a small stenosis can have significant ischemic potential if plaque burden or composition is high.
@Pablo
@alarmguy

more to come

 

[jetman]

Risk interpretation:
Short-term: With 15–20% stenosis and mixed plaque, the immediate risk of acute coronary events is low, but the plaque’s mixed composition suggests a higher biological activity and potential for progression.

Long-term: Mixed plaque burden and location in a high-flow vessel like the proximal LAD are linked to increased risk of future cardiovascular events.

Prognostic factors for MACE in LAD disease include high plaque burden, mixed plaque, diabetes, chronic kidney disease, and obstructive CAD

 

[jetman]

Management considerations:

• Medical therapy: Continue statins, antiplatelets, and control of risk factors (blood pressure, lipids, diabetes, smoking). These can slow plaque progression and stabilize mixed plaque.
• Monitoring: Regular follow-up with CCTA or stress testing may be considered if risk factors are present or symptoms develop.
• Revascularization: Not typically indicated for mild stenosis without symptoms, but may be considered if symptoms progress, plaque burden increases, or other risk factors are present.

 

[jetman]

The Bottom line:
This finding suggests a small but biologically active plaque in a critical artery. While the stenosis is mild, the mixed plaque composition and proximal LAD location warrant attention to cardiovascular risk factors and regular monitoring to prevent progression.

Decisions Decisions?

 

[jetman]

Medicare and my supplement was billed $4732 = 100%
$0 out of pocket for me

 

[Astro14]

The bottom line is that you need a good cardiologist, not an Internet forum.

 

[Pablo]

The Bottom line:
This finding suggests a small but biologically active plaque in a critical artery. While the stenosis is mild, the mixed plaque composition and proximal LAD location warrant attention to cardiovascular risk factors and regular monitoring to prevent progression.

Decisions Decisions?

Nattokinase and daily exercise

 

[jetman]

I've highlighted in bold what I find concerning
My CTTA Report also states:
CHEST:
The visualized portions of the lungs are clear. Central airways are patent. No pleural effusion or pneumothorax. Visualized portions of upper abdomen are unremarkable. Included osseous structures are unremarkable forage.

VASCULATURE:
Visualized portions of the thoracic aorta are normal in caliber without evidence for aneurysm or dissection. Visualized portions of the pulmonary arteries are normal in caliber without filling defect. Dilated aortic root at sinus of Valsalva measuring 4 x 4.1 x 3.9 cm. Mild calcified and noncalcified aortic valve thickening.

CARDIAC FINDINGS:
Cardiac chambers have normal size. Myocardial thickness and density are normal. No atrial or ventricular septal defect. No intracardiac filling defects. Pulmonary veins are unremarkable. No pericardial abnormality. Cardiac wall motion is normal. Cardiac valves have a normal CT appearance. Aortic valve is tricuspid trileaflet. There is no evidence for aortic valve stenosis. Incomplete diastole coaptation of theaortic valve leaflets due to aortic valve regurgitation.

LEFT VENTRICULAR FUNCTIONAL ANALYSIS:
Left ventricular ejection fraction: 69.0%
Myocardial mass: 142.1 g
Stroke volume: 95.8 ml
End-diastolic volume: 139.2 ml
End-systolic volume: 43.4 ml
Cardiac output: 6.0 l/min

FFRct: Not recommended based upon FFRct ordering guidelines.

Plaque Quant: Recommended based upon quantitative plaque ordering guidelines.

IMPRESSION:
1. Minimal stenosis of the proximal left anterior descending coronary artery. CAD-RADS.1% stenosis: 1-24%. Interpretation: Minimal non-obstructive CAD or plaque with no stenosis. Further Cardiac Investigation: Consider preventative therapy and risk factor modification.
2. Dilated aortic root at sinus of Valsalva. Findings suggestive of Aortic valve regurgitation.

Signed on 4/20/2026 12:38 PM by XYZ, M.D.

End of report

 

[Astro14]

@jetman - You’re seeking medical advice. We can’t offer that here. I’m serious when I say that you need a good cardiologist. Get your answers from a medical professional, not BITOG.