Cardiac CT-guided versus Intravascular Ultrasound-guided Percutaneous Coronary Intervention for Noncomplex Coronary Lesions

Background: Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is recommended for complex lesions, but has limited adoption due to cost and procedural time constraints. Cardiac CT provides detailed preprocedural information without additional equipment. It is hypothesised that CT-guided PCI could reduce procedural time compared with IVUS-guided PCI in noncomplex coronary lesions. Methods: This single-centre, retrospective study compared two sequential cohorts: IVUS-guided PCI (January 2021 to April 2023) and CT-guided PCI (May 2023 to July 2025). After excluding complex lesions, 38 patients were included: 23 CT-guided and 15 IVUS-guided. Procedure time was defined as duration from first contrast injection through the guiding catheter to final angiography confirming stent deployment. Results: Procedure time was shorter in the CT-guided group (median 25 minutes) compared with the IVUS-guided group (median 43 minutes; p=0.028). However, the CT-guided group also had significantly shorter lesion lengths and stent lengths. The CT-guided group showed excellent correlation between CT-measured reference diameters and actual stent size (Spearman’s ρ=0.682; p<0.001) with minimal sizing disparity (median difference 0.1 mm). No significant differences occurred in fluoroscopy time, contrast volume or complications. Conclusion: In this preliminary investigation, CT-guided PCI was associated with reduced procedural time in noncomplex lesions while maintaining excellent stent sizing accuracy. However, differences in baseline lesion characteristics limit causal inference. This hypothesis-generating study warrants further investigation with matched cohorts or adjusted analyses to determine the true impact on catheterisation laboratory efficiency.