The role of coronary computed tomography angiography in the interventions of calcified coronary lesions: A case series

Heavily calcified coronary lesions pose significant challenges during percutaneous coronary intervention (PCI), with increased risks of stent under-expansion and procedural complications. Computed tomography coronary angiography (CCTA) has emerged as a useful tool for lesion assessment and procedural planning, particularly when validated against intravascular imaging. We present three patients with high coronary calcium scores (>400) undergoing PCI. CCTA provided detailed vessel sizing and lesion morphology, which was confirmed by intravascular optical coherence tomography (OCT). Lesion preparation included non-compliant balloon angioplasty and intravascular lithotripsy, followed by drug-eluting stent implantation. OCT validation confirmed adequate stent expansion and apposition, identified peri-procedural complications, and guided further optimization. All cases achieved satisfactory angiographic and clinical outcomes. The series demonstrates the complementary role of CCTA and OCT in managing complex, heavily calcified coronary disease. CCTA enabled accurate pre-procedural planning, while OCT validation ensured procedural safety and stent optimization. CCTA-guided PCI, with OCT confirmation, may improve outcomes in patients with severe coronary calcification. Larger studies are needed to establish CCTA as a reliable tool for guiding complex PCI.