WASHINGTON—A new expert opinion document jointly released by the Society for Cardiovascular Angiography and Interventions (SCAI) and the Society of Cardiovascular Computed Tomography (SCCT) presents a comprehensive framework for using coronary computed tomography angiography (CCTA) to guide percutaneous coronary intervention (PCI).
Published in JSCAI, "Coronary Computed Tomography Angiography to Guide Percutaneous Coronary Intervention: Expert Opinion from a SCAI/SCCT Roundtable" was developed through an October 2024 multidisciplinary roundtable, reflecting the complexity and collaborative nature of this evolving field. It was unveiled at a joint SCAI/SCCT symposium during the SCAI 2025 Scientific Sessions in Washington, DC.
"Many patients already undergo coronary CT as part of their workup. Our goal is to use that existing data to plan procedures more intelligently, reduce complications, and deliver more precise care," said Yader Sandoval, MD , FSCAl, Chair of the roundtable and interventional cardiologist at Minneapolis Heart Institute. "This was more than just a conversation—it was a convergence of specialties. We had imagers who've read hundreds of thousands of scans, and interventionalists who do complex PCI every day, sitting side by side. And the goal was singular: improve outcomes by leveraging the CT scans we're already performing."
The document reflects the collective insights of leaders in cardiac imaging, interventional cardiology, and clinical trial design to address an emerging frontier: how to apply CT in a practical, step-by-step way to improve PCI outcomes. They sought to address a critical gap in practice: while coronary CT is routinely used to evaluate stable chest pain and assess coronary anatomy, its use in PCI preprocedural planning has remained underutilized. With expanding evidence of benefits that include the potential for reduced procedure time and radiation exposure, clinical interest has been growing, and the need for a practical, clinician-driven roadmap was clear.
"This wasn't just an academic exercise—it was practical and forward-looking," said Carlos Collet, MD, PhD , interventional cardiologist at OLV Clinic in Aalst, Belgium, and contributing author. "We discussed real-world applications: How do I look at a CT and know the plaque morphology? How do I estimate vessel size or predict wire path through a complex occlusion? This document translates those answers into step-by-step guidance."
A major theme throughout the roundtable was bridging the gap between imaging and intervention. Unlike traditional diagnostic coronary CT, which may be interpreted by imagers alone, CT-guided PCI requires collaboration between specialists to fully harness both anatomic and physiologic data.
Jonathon Leipsic, MD , Co-Chair of the roundtable and radiologist at St. Paul's Hospital in Vancouver, British Columbia, emphasized this interdisciplinary approach. "CT has long been foundational to planning structural heart interventions, where collaboration is baked into the workflow," he said. "Now we're applying that same philosophy to coronary disease. This document outlines current evidence and future opportunities, and importantly, it helps democratize the field. You don't have to be a CT expert to start using these tools. We're giving people a guide to get on the escalator—wherever they are—and move upward."
In addition to detailed recommendations on image acquisition and interpretation, the document outlines the role of CT-derived fractional flow reserve (FFRCT) and virtual PCI modeling. These tools allow clinicians not only to evaluate anatomical stenosis, but also to predict the physiologic benefit of an intervention before it occurs. The consensus also delves into case selection, triage, lesion classification, equipment planning, and procedural strategy.
"The reason I'm so excited about this document is how practical it is," said Emmanouil S. Brilakis, MD, PhD, FSCAI , interventional cardiologist at Minneapolis Heart Institute. "Interventionalists want a clear roadmap—how do I go from opening a CT to knowing what stent to use? This document walks through that process. And it's not just about what's possible—it's also candid about what's needed, like better software, more training, and reimbursement policies that match the value of the approach."
The authors stressed the importance of education and collaboration in ensuring broader adoption. Training remains a key hurdle—many interventional cardiologists have limited exposure to cardiac CT interpretation. To address this, the roundtable emphasized the need for ongoing education, hands-on workshops, and software platforms tailored for proceduralists.
"We can't move the field forward unless we train the next generation of interventionalists to see CT as a tool in their hands. That's why we built this document to be a foundation for future programs—whether that's an in-lab training module or a fellowship curriculum," said Dr. Sandoval.
New clinical evidence is expected to reinforce the guidance provided. Trials like the P4 Study, which involves global participation, will add randomized data supporting CT-guided PCI in complex lesions. As this data emerges, the authors said they expect the field to evolve rapidly—and for CT to become a routine part of the planning of coronary interventions, as it already is in structural heart procedures.
The collaboration between SCAI and SCCT reflects growing recognition that planning coronary interventions requires both anatomic and physiologic insight. CT is well-positioned to offer both—and to do so noninvasively, before the patient ever enters the cath lab.
"This is a defining moment for interventional cardiology," said Dr. Leipsic. "We know we can improve patient outcomes by planning better. CT helps us do that. Now we have a playbook."
The roundtable was supported through an unrestricted educational grant from Shockwave Medical, Inc.
DOI: 10.1016/j.jscai.2025.103664
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