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<p>Slender percutaneous coronary intervention (PCI) is a minimally invasive technique that uses smaller catheters, typically 5-French devices, to reduce bleeding complications and eliminate the need for unnecessarily large catheters. While these techniques are highly effective for non-complex lesions, they face inherent challenges, such as limitations in device compatibility and technical constraints. These challenges emphasize the importance of thorough pre-procedural planning to ensure optimal equipment selection and successful procedures. Cardiac computed tomography (CT) addresses these limitations by providing a comprehensive three-dimensional view of the coronary artery anatomy and lesion characteristics. This consensus statement outlines the role of cardiac CT in optimizing slender PCI strategies, emphasizing the importance of detailed anatomical assessments and advanced evaluations of lesion complexity. Cardiac CT enables precise measurements of vessel dimensions, identification of optimal landing zones, and accurate characterization of lesion complexity, including calcified plaque. Thin-slab maximum intensity projection reconstruction provides simultaneous longitudinal and cross-sectional views, comparable with findings of coronary angiography and intravascular imaging, facilitating interventional planning. For complex lesions, CT is essential. It accurately predicts the risk of side branch occlusion in bifurcation lesions, characterizes the distribution of calcification in heavily calcified lesions to aid in device selection, and helps in the appropriate selection of cases for chronic total occlusion lesions based on CT-derived scores and detailed morphological assessments. To systematically apply these principles, a practical pre-procedural checklist for CT-guided planning is proposed. The integration of cardiac CT into the slender PCI workflow extends beyond anatomical assessment to encompass the optimization of resource utilization, potentially enabling interventionists to proceed with appropriately minimally invasive techniques from the outset.</p>

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Consensus document on the role of cardiac computed tomography for pre-procedural planning in minimally invasive percutaneous coronary intervention from the Japanese association of cardiovascular intervention and therapeutics

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月3日

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  • Kenji Sadamatsu,
  • Fuminobu Yoshimachi,
  • Naoki Masuda,
  • Shinichiro Yamada,
  • Tomokazu Ikemoto,
  • Nozomi Kotoku,
  • Munenori Okubo,
  • Yoshio Kobayashi,
  • Ken Kozuma

摘要

Slender percutaneous coronary intervention (PCI) is a minimally invasive technique that uses smaller catheters, typically 5-French devices, to reduce bleeding complications and eliminate the need for unnecessarily large catheters. While these techniques are highly effective for non-complex lesions, they face inherent challenges, such as limitations in device compatibility and technical constraints. These challenges emphasize the importance of thorough pre-procedural planning to ensure optimal equipment selection and successful procedures. Cardiac computed tomography (CT) addresses these limitations by providing a comprehensive three-dimensional view of the coronary artery anatomy and lesion characteristics. This consensus statement outlines the role of cardiac CT in optimizing slender PCI strategies, emphasizing the importance of detailed anatomical assessments and advanced evaluations of lesion complexity. Cardiac CT enables precise measurements of vessel dimensions, identification of optimal landing zones, and accurate characterization of lesion complexity, including calcified plaque. Thin-slab maximum intensity projection reconstruction provides simultaneous longitudinal and cross-sectional views, comparable with findings of coronary angiography and intravascular imaging, facilitating interventional planning. For complex lesions, CT is essential. It accurately predicts the risk of side branch occlusion in bifurcation lesions, characterizes the distribution of calcification in heavily calcified lesions to aid in device selection, and helps in the appropriate selection of cases for chronic total occlusion lesions based on CT-derived scores and detailed morphological assessments. To systematically apply these principles, a practical pre-procedural checklist for CT-guided planning is proposed. The integration of cardiac CT into the slender PCI workflow extends beyond anatomical assessment to encompass the optimization of resource utilization, potentially enabling interventionists to proceed with appropriately minimally invasive techniques from the outset.