Coronary CT Angiography in PCI Planning: Advances, Clinical Applications, and Challenges

Area of Science:

• Interventional Cardiology
• Cardiovascular Imaging
• Medical Technology

Background:

• Coronary computed tomography angiography (CTCA) is transitioning from a diagnostic tool to a comprehensive planning instrument for percutaneous coronary intervention (PCI).
• Technological advancements, including CT-derived fractional flow reserve (FFR-CT) and AI-powered plaque analysis, enhance CTCA's utility beyond initial diagnosis.
• These innovations enable detailed visualization, functional assessment, and identification of adverse plaque characteristics, improving procedural planning and patient outcomes.

Purpose of the Study:

• To review the evolving role of CTCA in interventional cardiology.
• To highlight the impact of technological advancements on CTCA applications in PCI planning.
• To discuss the benefits and challenges of integrating CTCA into routine procedural workflows.

Main Methods:

• Review of current literature on CTCA in interventional cardiology.
• Analysis of technological innovations such as FFR-CT and AI in CTCA.
• Examination of CTCA's application in complex PCI scenarios like chronic total occlusions (CTOs).

Main Results:

• CTCA provides high-resolution 3D visualization of coronary anatomy and functional information (FFR-CT).
• AI enhances CTCA by automating workflows, improving plaque analysis, and identifying high-risk plaque features.
• CTCA is valuable for planning complex PCI, including CTO interventions, vessel sizing, and stent selection.

Conclusions:

• CTCA is an increasingly vital adjunct for PCI planning, integrating anatomical, physiological, and plaque information.
• It serves as a pre-procedural roadmap, guiding lesion selection, stent strategy, and calcium modification.
• Barriers to wider implementation include calcification blooming, radiation, contrast concerns, and workflow integration challenges.