Prof. Mariusz Kruk presented CT-guided revascularization as a new paradigm in interventional cardiology, where Coronary CT Angiography (CCTA) and CT-derived Fractional Flow Reserve (CT-FFR) serve not merely as diagnostic tools but as comprehensive instruments for patient qualification, treatment planning, and procedural preparation.
Through a series of illustrative clinical cases, he demonstrated how CCTA + CT-FFR enable:
- Accurate identification of patients requiring revascularization, combining anatomical and physiological lesion assessment.
- Evidence-based Heart Team decisions, supported by detailed visualization of plaque distribution, vessel geometry, and lesion physiology - guiding the optimal choice between PCI and CABG.
- Thorough pre-interventional planning, including stent sizing, landing-zone definition, and evaluation of lesion morphology - particularly crucial in complex, calcified, or CTO lesions.
Prof. Kruk emphasized that the pre-procedural nature of CCTA uniquely allows operators to plan every aspect of revascularization before entering the cath lab, including anticipation of calcium modification requirements (such as atherectomy or intravascular lithotripsy) based on quantitative plaque analysis and calcium burden assessment.
He highlighted that with photon-counting CT scanners and advanced reconstruction software, CCTA has achieved a level of technical and clinical maturity that permits reliable evaluation even in heavily calcified or post-stent segments.
These advances allow clinicians to obtain diagnostic and functional data comparable to invasive angiography with IVUS, OCT, or FFR, while in most cases eliminating the need for purely diagnostic catheterization.
This pre-interventional, non-invasive workflow enhances decision accuracy, procedural safety, and cath-lab efficiency — supporting faster recovery and even same-day discharge.
CT-guided revascularization integrates anatomy, physiology, and strategy — transforming CCTA into a true interventional planning platform for modern coronary care.
CCTA for CTO PCI - From Diagnosis to Procedural Navigation
Prof. Mariusz Kruk presented the pivotal role of Coronary CT Angiography (CCTA) in the management of Chronic Total Occlusions (CTO) - supporting every step of care, from diagnosis and qualification to detailed procedural planning and intra-procedural navigation.
He underscored that CCTA provides a comprehensive visualization of all anatomical factors determining procedural strategy - vessel course, occlusion length, entry morphology, calcium distribution, side branches, and distal vessel quality - in far greater detail than conventional invasive coronary angiography (ICA).
The only element beyond its current reach remains the fine collateral network, particularly septal and bridging channels.
By precisely delineating the occlusion pathway and vessel architecture, CCTA enables accurate selection of access route, guidewire strategy, and device choice, while helping to anticipate technical difficulties and procedural risks.
Modern CCTA, integrated with 3D reconstruction and cath lab co-registration, serves as a true anatomical roadmap during PCI - improving operator orientation and efficiency.
Prof. Kruk emphasized that CCTA-guided CTO revascularization has been associated with higher procedural success rates, reduced fluoroscopy time, and lower contrast use, demonstrating measurable impact on clinical outcomes.
He concluded that with growing operator expertise and integration of CT data into PCI planning systems, CCTA has evolved from a diagnostic tool into an indispensable component of complex coronary intervention.
“CCTA shows everything that defines strategy - often better than angiography itself - and has proven to make complex CTO interventions safer, faster, and more successful.”
17th Indonesia Society of Interventional Cardiology Annual Meeting (ISICAM) 2025
This presentation “CT-Guided Revascularization Strategy,” was presented by Prof. Mariusz Kruk, MD, PhD of National Institute of Cardiology, Warsaw, Poland.
The ISICAM (Indonesian Society of Interventional Cardiology Annual Meeting) is the largest gathering of renowned experts from Indonesia, which also involves speakers and attendees from neighboring regions, and beyond. This momentous event aims to facilitate a dynamic exchange of knowledge, ideas, and best practices in interventional cardiology, with a special focus on addressing the unique challenges faced by cath lab laboratories in resource-constrained settings.
For more information, click this link: https://isicam.id/
Written by
Prof. Mariusz Kruk, MD, PhD, is a cardiologist and clinical researcher at the National Institute of Cardiology in Warsaw, Poland. He specializes in coronary imaging and precision diagnostics, including coronary CT angiography, CT‑guided PCI, CT perfusion, FFR‑CT, and AI‑based biomarkers. Prof. Kruk leads international, competitively funded studies, serves as an EACVI CT educator, and focuses on translating advanced imaging into improved patient outcomes through clinical practice and collaborative research worldwide.