Episode # 40 • 23 Jun 2026
Maximizing Success in CTO Procedures with CT Imaging
Can cardiac CTA take the guesswork out of complex CTO (chronic total occlusion) procedures? In this episode of Backtable Cardiology, host Dr. Hady Lichaa interviews interventional cardiologist and CTO operator Dr. Anbukarasi Maran about how advanced CT imaging is changing the landscape of CTO PCI (percutaneous coronary intervention) planning. They discuss workflow for integrating photon-counting CT, collaboration with radiologists, and why this approach is being adopted for pre-procedure planning in CTO cases, reflecting its growing use in structural heart interventions.
Timestamps
00:00 - Introduction
03:04 - Why CTA for CTO
05:24 - CTA Workflow and Photon Counting
07:15 - Key CTA Findings for Strategy
12:12 - In Lab CTA Overlay Case Example
15:20 - Planning for All Operators
17:07 - Guide Selection and Efficiency
18:23 - Reading CTA and Teamwork
22:46 - Photon Counting for Stents
24:01 - Limitations Kidney Rate BMI
31:13 - Building a CTA Program
33:26 - Wrap Up and Credits
Resources
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More about this episode
Dr. Maran describes a workflow using photon-counting CT, when available, to reduce calcium blooming and to better assess plaque and stents. She emphasizes close collaboration with radiologists for 3D reconstruction, vessel course mapping, calcification patterns, landing zones, collateral selection, and resolving proximal cap ambiguity. Dr. Maran notes that CTA can reduce repeat diagnostic catheterizations, improve time efficiency, guide device selection, and help anticipate the need for calcium-modifying tools, while not replacing intravascular imaging. Limitations discussed include renal function (avoiding CTA when creatinine is greater than two), occasional misleading findings in heavy calcium, heart-rate control challenges, and high BMI affecting image quality. She advises launching programs through multidisciplinary champions, administrative value framing, and careful reimbursement planning.
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