The role of coronary computed tomography angiography in coronary bifurcation disease: a scoping review

Coronary disease frequently affects artery bifurcations, leading to unique considerations in diagnosing and managing obstructive disease. Coronary computed tomography angiography (CCTA) is a noninvasive three-dimensional cross-sectional imaging modality that can define plaque distribution within vessel walls, providing diagnostic and management information in bifurcation lesions (BL). This review summarizes the available literature on the role of CCTA in defining BLs and guiding intervention. We conducted a scoping review using Medline, Embase, Emcare, and Web of Science databases for articles published between 1946 and 2025 and did back searching with Google Scholar. We screened 575 articles and identified 48 for inclusion in this study. CCTA has been used to characterize multiple aspects of coronary bifurcations, including bifurcation anatomy, bifurcation angles, as well as plaque location, distribution and morphological characteristics at bifurcations. CCTA can support the accurate diagnosis of non-calcified obstructive bifurcation disease. Large left-main bifurcation angles can indicate the presence of obstructive coronary disease. CCTA demonstrates bifurcation PCI planning potential; CCTA can identify optimal fluoroscopic viewing angles of BL, accurately measure bifurcation angles for procedural planning, identify anatomically relevant side branches, predict SB occlusion and inform the selection of stenting technique. CCTA shows promise in ruling out in-stent restenosis and assessing stent characteristics in patients with left main bifurcation PCI. Ultimately, CCTA can be used to characterize bifurcation anatomy, diagnose BLs, support PCI planning, and assess stent characteristics and patency post-PCI. Future studies with larger sample sizes, multi-center, and prospective designs are needed to consolidate the role of CCTA in BL intervention.