Guidance of percutaneous coronary interventions by multidetector row computed tomography coronary angiography

Guidance of percutaneous coronary interventions (PCI) by intravascular ultrasound (IVUS) provides more precise information in terms of quantitative measurement and qualitative assessment of coronary artery disease (CAD) than does conventional angiography.(1,2) Several studies have tested the efficacy of IVUS to guide stent implantation.(3-9) However, the conflicting results have left behind a continued debate as to whether IVUS-guided PCI has an impact on clinical outcome and angiographic restenosis. IVUS and computed tomography coronary angiography (CTCA) share the ability to evaluate the lumen along with the vessel wall, enabling characterisation of proximal and distal reference segments. Nevertheless, IVUS imaging is expensive and usually precluded in severe stenoses. In the present article, we discuss the potential application of CTCA for the guidance of PCI, particularly of complex lesions such as chronic total occlusions (CTO) and bifurcations.