On Demand: Beyond Stenosis: Identifying Ischemic Risk in Non-Obstructive CAD-Presentation Slides

Presentation Slides

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This presentation argues that coronary artery disease (CAD) risk is driven by more than stenosis alone. It emphasizes that many heart attacks and major adverse cardiovascular events (MACE) arise from non-obstructive, high-risk plaque that may not cause symptoms, ischemia, or major narrowing on traditional testing.<br /><br />Key themes include:<br />- Cardiovascular disease remains the leading cause of death, including among asymptomatic adults.<br />- Symptoms, ischemia, and stenosis are incomplete surrogates for true disease burden.<br />- Plaque morphology matters: non-calcified, low-attenuation, and heterogeneous plaques are more predictive of events than calcified plaque alone.<br />- Risk stratification should focus on plaque burden, plaque type, vessel remodeling, and lesion-level analysis rather than stenosis severity by itself.<br /><br />The talk highlights evidence that:<br />- Many future culprit lesions are non-obstructive.<br />- High-risk plaque is associated with higher risk of MI, ischemia, rapid progression, and poor medication response.<br />- Women may carry higher relative risk from high-risk plaque features despite not having greater stenosis severity.<br /><br />Cleerly’s approach is presented as a noninvasive AI-based solution that combines:<br />- Cleerly LABS for plaque quantification and characterization,<br />- Cleerly ISCHEMIA for plaque-based ischemic risk prediction,<br />- Cleerly COMPARE for longitudinal disease tracking.<br /><br />The ISCHEMIA algorithm uses 37 anatomical parameters and is positioned as comparable in concept to several gold-standard invasive or advanced tests, including FFR, QCA, IVUS, OCT, and NIRS. Studies cited suggest Cleerly may outperform FFRCT and SPECT for both diagnostic and prognostic performance, and may correlate well with PET myocardial blood flow and IVUS plaque measurements.<br /><br />A case study illustrates clinical utility: a patient with normal prior stress tests and rapidly rising CAC had lesion-level findings on Cleerly that supported urgent invasive evaluation, leading to identification and PCI treatment of a culprit mid-LAD lesion.

Keywords

coronary artery disease

high-risk plaque

non-obstructive plaque

major adverse cardiovascular events

plaque morphology

plaque burden

ischemia prediction

AI-based cardiac imaging

women cardiovascular risk

Cleerly