Abstract
BACKGROUND: Severe calcified lesions are difficult to assess using conventional coronary computed tomography angiography (CCTA). Artificial intelligence (AI)-driven reconstruction may help address this limitation. CASE SUMMARY: A 93-year-old man with angina underwent AI-enhanced high-resolution CCTA using the Aquilion ONE/INSIGHT Edition (Canon Medical Systems). The AI-enhanced imaging clearly revealed severe eccentric calcification from the distal left main trunk to the proximal left anterior descending artery. Intravascular ultrasound confirmed this finding. Percutaneous coronary intervention (PCI) was performed with orbital atherectomy, cutting balloon predilation, and drug-eluting stent implantation, achieving good stent expansion. DISCUSSION: AI-enhanced CCTA enabled the accurate visualization and measurement of calcified plaques, including their arc and thickness, facilitating the selection of appropriate devices and lesion preparation for PCI. TAKE-HOME MESSAGES: AI-enhanced CCTA provides precise evaluation of severely calcified coronary plaques. It guides PCI strategy by accurately assessing calcium burden and plaque morphology.