Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can be technically complex. Coronary computed tomography angiography (CCTA) is increasingly being used for planning CTO PCI. CCTA can help evaluate cap morphology, lesion length, calcification, and distal vessel quality. Use of CCTA for CTO PCI may be enhanced by integration with artificial intelligence and real-time imaging. In a randomized-controlled trial, pre-procedural CCTA increased the success of CTO PCI. In this review, we describe how CCTA 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.
EditorsEditor-in-ChiefHarlan M. Krumholz, MD, SM, FACC CME EditorRagavendra R. Baliga, MDAuthorSant Kumar, MD
Important DatesDate of Release: January 12, 2026Term of Approval/Date of CME/MOC Expiration: January 11, 2027