Coronary Computed Tomography Angiography for the Diagnosis and Revascularization Guidance of Coronary Bifurcation Lesions: A Contemporary Review.
Authors
Affiliations (6)
Affiliations (6)
- Medica Cor Hospital, Riga 35 Str, 7013 Ruse, Bulgaria.
- Faculty of Cardiology, Pulmonology and Endocrinology, Medical University of Pleven, 5800 Pleven, Bulgaria.
- Faculty of Public Health and Health Care, Ruse University "Angel Kanchev", 7000 Ruse, Bulgaria.
- Department of Interventional Cardiology and Internal Diseases, Military National Research Institute, Zegrzynska 8 Str, 05-118 Legionowo, Poland.
- Cardiology Department, Ospedali Riuniti Padova Sud, 35-121 Padova, Italy.
- Cardiology Department, National Medical Institute of Internal Affairs and Administration Ministry, 02-507 Warsaw, Poland.
Abstract
<b>Background</b>: Coronary bifurcation lesions represent one of the most technically demanding scenarios in coronary artery disease (CAD), associated with higher procedural complexity, restenosis, and periprocedural complications. Recent advances in coronary computed tomography angiography (CCTA) have markedly improved its ability to visualize complex coronary anatomy, assess plaque morphology, and guide revascularization. <b>Objectives</b>: This review summarizes (1) technological advances in CCTA over the last decade, (2) its role in evaluating bifurcation stenosis, (3) assessment of plaque morphology and distribution, (4) quantification of bifurcation geometry, and (5) emerging evidence supporting its application in revascularization planning and guidance. <b>Findings</b>: Modern wide-detector and dual-source CT systems, iterative and deep-learning reconstruction algorithms, and photon-counting CT (PCCT) have significantly improved temporal and spatial resolution, reduced blooming artifacts, and lowered radiation dose. CCTA now reliably quantifies bifurcation stenosis and plaque distribution, characterizes high-risk plaque features, and accurately measures bifurcation angles. The integration of CT-derived fractional flow reserve (FFR-CT) and artificial intelligence (AI)-based plaque quantification further strengthens its diagnostic and prognostic performance. CCTA-derived bifurcation scores and 3D modelling support procedural strategy selection, stent sizing, and side-branch (SB) protection. <b>Conclusions</b>: CCTA has evolved into a comprehensive tool for non-invasive diagnosis, physiological assessment, and pre-procedural planning of bifurcation disease. With the advent of PCCT and AI-enhanced quantitative tools, CCTA is poised to become a central component of revascularization decision-making in complex coronary bifurcations.