What should I think about if I have a computed tomography angiogram?

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Anthony L. Komaroff, MD
Internal Medicine
There are several issues to consider before undergoing a computed tomography (CT) angiogram. First, not all CT scanners are created equal. If you opt for a CT angiogram, make sure the device is the latest generation. Second, although the scans are noninvasive, they do carry risks. Perhaps the most significant issue, though, is that the scans may reveal partial blockages that might not otherwise have been visible. While this may seem like a good thing, it's not clear that it is. Some people will want to "fix" these with angioplasty and coronary artery bypass surgery rather than trying lifestyle changes and medications. This can lead to greater expense and greater risk for complications, and it is not clear that going after these narrowings in people who have no symptoms helps them avoid heart attacks or live longer. Nor is it clear yet whether using CT scans in place of angiograms will improve health outcomes -- ultimately the most important consideration. For these reasons, many insurance companies do not pay for CT angiograms, and they are not routinely used.