The Role of Coronary Computed Tomography Angiography in Chronic Total Occlusion Percutaneous Coronary Intervention

Abstract

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be technically complex. Coronary computed tomography angiography (CTA) is increasingly being used for planning CTO PCI. Coronary CTA can help evaluate cap morphology, lesion length, calcification, and distal vessel quality. The use of coronary CTA for CTO PCI may be enhanced by integration with artificial intelligence and real-time imaging. In a randomized controlled trial, preprocedural coronary CTA increased the success of CTO PCI. In this review, the authors describe how coronary CTA can help diagnose and characterize CTO lesions, estimate the time needed for guidewire crossing time, predict and facilitate CTO PCI technical success, and provide real-time procedural guidance. (JACC Cardiovasc Interv. 2026;19:1-14) (c) 2026 by the American College of Cardiology Foundation.