CCTA being used more and more to plan ahead before complex PCI
Coronary computed tomography angiography (CCTA) is rapidly evolving from a diagnostic imaging tool into an important resource for planning complex coronary interventions, particularly chronic total occlusion (CTO) procedures. This trend has been increasingly evident at interventional cardiology conferences and was a trend highlighted at SCCT2026, the Society of Cardiovascular Computed Tomography (SCCT) 2026 annual meeting.
As CCTA continues to expand, interventional cardiologists are finding expanding access to CT imaging, which is offering a shift in how they approach procedures, explained Yader Sandoval, MD, an interventional cardiologist at Minneapolis Heart Institute and adjunct associate professor of medicine at Mayo Clinic. He presented on this topic at SCCT and spoke with Cardiovascular Business in the above video interview.
Sandoval said interventional cardiologists are increasingly using CT scans obtained before procedures to better understand coronary anatomy, plaque characteristics and lesion complexity before entering the catheterization laboratory. He said the information also informs clinical decisions, such as if surgery might be better, or if the case is so complex it should be referred to a more experienced center.
"For a long time CT has been used primarily for diagnosis," Sandoval explained. "Now we're looking beyond diagnosis and using all of the information contained in the scan to develop an intelligent procedural plan before we enter the cath lab."
He said growing clinical evidence, improved image quality and more sophisticated visualization software are driving the adoption of CT-guided PCI planning. Several clinical trials have demonstrated benefits, including improved procedural success in CTO interventions and more efficient treatment of patients with prior coronary artery bypass graft surgery. Additional studies evaluating virtual PCI planning with fractional flow reserve CT (FFR-CT) are also underway. Some vendors already offer CCTA tools that incorporate AI plaque and FFR-CT analysis that can help with preplanning. Heartflow's PCI Navigator is currently the only dedicated platform specifically to pre-plan PCIs.
Sandoval noted that interventional cardiologists are becoming much more engaged with cardiac CT, a trend reflected by increasing CT-focused sessions at interventional cardiology meetings and greater collaboration between imagers and interventionists.
"We're no longer working in silos," he said. "These multidisciplinary conversations have significantly expanded our understanding of coronary disease."
For CTO procedures, Sandoval said CT provides information that conventional angiography cannot fully characterize before intervention. Operators can assess the length of the occlusion, determine whether the proximal cap is tapered or ambiguous, evaluate plaque composition and calcium burden, identify side branches, and estimate myocardial territory at risk. Sandoval said this information allows physicians to better anticipate procedural complexity, select appropriate equipment and determine the optimal crossing strategy before the case begins.
CT imaging also improves discussions with patients, he said. Physicians can provide more personalized estimates of procedural success and risk based on the anatomy rather than relying on generalized expectations.
Similar to structural heart disease programs, Sandoval said coronary interventions could benefit from multidisciplinary evaluation based on advanced imaging findings. The technology also may help hospitals better allocate resources by identifying the most complex cases before the procedure, allowing them to schedule experienced operators, appropriate equipment and adequate procedure time.
Sandoval said CT planning has the potential to "democratize" expertise by helping operators who perform fewer CTO procedures achieve better outcomes through more comprehensive pre-planning. He pointed to the randomized CT-CTO trial, which found improved procedural success when CT guidance was incorporated into CTO planning.
Advances in photon-counting CT scanners may further expand CT's role by reducing calcium blooming artifacts and improving visualization of plaques or restenosis inside coronary stents. Sandoval said this could eventually make CT valuable not only for planning PCI, but also for evaluating stent performance and identifying causes of stent failure during follow-up.
While enthusiasm for CT-guided PCI continues to grow, Sandoval emphasized that adoption is being driven by evidence rather than technology alone.
"It's not just about pretty images or AI," he said. "We're seeing prospective studies and randomized clinical trials demonstrating the added value of CT to improve patient care."
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]