CT-guided PCI: From diagnosis to treatment planning

Computed tomography-guided percutaneous coronary intervention (CT-guided PCI) represents a new paradigm that extends coronary CT angiography (CCTA) from diagnostic imaging to procedural planning. By integrating morphological and physiological information, CCTA enables a comprehensive understanding of lesion characteristics and supports individualized revascularization strategies before PCI. Advances in myocardial mass quantification, CT-derived physiology, and three-dimensional co-registration have enhanced the procedural relevance of CCTA. Emerging technologies, such as photon-counting CT, are expected to further refine accuracy and broaden clinical applicability. These innovations are transforming CCTA from a diagnostic modality into a central platform for precision PCI planning. Currently, the clinical utility of CT-guided PCI is being actively evaluated across multiple prospective trials and registries, reflecting growing interest in its role for guiding contemporary PCI. Collectively, these developments are transforming CCTA from a diagnostic modality into a central platform for precision PCI planning. The goal of this review is to outline the concept, workflow, and clinical applications of CT-guided PCI, highlighting the transition of CCTA from diagnosis to comprehensive procedural design and decision-making.