Conversations in IC: Coronary Computed Tomography Angiography to Guide Percutaneous Coronary Intervention: Expert Opinion from a SCAI/SCCT Roundtable-Manuscript

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Coronary computed tomography angiography (CCTA) is increasingly valuable for the planning of percutaneous coronary intervention (PCI), traditionally used mainly for diagnostics. Recent developments and evidence suggest that CCTA can enhance preprocedural planning, patient triage, shared decision-making, and resource allocation in PCI procedures. The Society for Cardiovascular Angiography & Interventions (SCAI) and the Society of Cardiovascular Computed Tomography (SCCT) convened a roundtable of experts to address how CCTA can systematically guide PCI procedures.<br /><br />Key findings highlight the potential of CCTA to serve PCI in several ways. CCTA allows for detailed assessment, identifying disease complexity, lesion morphology, and vessel dimensions critical for device selection. It provides a non-invasive alternative that complements intravascular imaging and physiology by improving procedural planning and reducing complications. <br /><br />CCTA is well-suited for analyzing certain lesion subsets, including severely calcified lesions, bifurcation lesions, diffuse versus focal coronary artery disease (CAD), aorto-ostial and chronic total occlusions, and lesion planning in patients with prior coronary artery bypass grafts (CABG).<br /><br />Several trials support CCTA's efficacy. For instance, randomized studies have shown improved outcomes with CCTA-guided PCI in chronic total occlusions and aorto-ostial lesions, while trials like P4 are expected to provide comprehensive data on CCTA's effectiveness.<br /><br />Challenges exist in implementing CCTA-guided PCI, including the need for contemporary CCTA scanners, better visualization tools for clinicians, expanded training, and more definitive trials to validate CCTA's impact. Collaboration among various healthcare stakeholders is critical to overcoming these obstacles and integrating CCTA into routine clinical practice for PCI guidance. The document underscores the evolving role of CCTA in enhancing procedural success, patient outcomes, and healthcare efficiency when implemented effectively with suitable training and technology.

Keywords

Coronary computed tomography angiography

CCTA

percutaneous coronary intervention

PCI

procedural planning

Society for Cardiovascular Angiography & Interventions

SCAI

Society of Cardiovascular Computed Tomography

SCCT

chronic total occlusions