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CT-Guided Stenting Matches Ultrasound in New Trial

Adults undergoing coronary angioplasty may see comparable outcomes with CT-guided or drug-coated balloon approaches in these trials.

Updated on Nov. 2, 2026 in Heart Disease

Isometric editorial illustration of two slender metal coronary stents of different design standing side by side beside a coiled balloon catheter on a plain matte surface.
Two new trials presented at TCT 2026 found CT-guided stent placement and a sirolimus-coated balloon each performed comparably to standard approaches in coronary angioplasty. AI Illustration. Upload story photo >

Two trials presented at TCT 2026 offer new evidence on coronary stenting. In the P4 trial, CCTA-guided PCI was found noninferior to IVUS-guided PCI for target-vessel failure at 12 months, while the TRANSFORM II trial found a sirolimus-coated balloon noninferior to everolimus drug-eluting stents in native coronary arteries.

Why it matters

For people undergoing angioplasty and stenting for coronary artery disease, the findings suggest that a CT-based imaging approach to guiding the procedure can achieve outcomes comparable to intravascular ultrasound, and that a drug-coated balloon can perform comparably to a drug-eluting stent in selected cases. These results may inform how cardiologists plan procedures and which devices are considered, though both trials report noninferiority rather than superiority.

The P4 trial randomized 1,105 patients to CCTA-guided or IVUS-guided PCI and followed them for 12 months, while TRANSFORM II randomized 1,842 patients across 53 sites in Europe, Southeast Asia and Brazil. Both trials report noninferiority outcomes, and longer-term results beyond the reported follow-up windows are not described in the source.

The players

TCT 2026

TCT is a major annual interventional cardiology conference where new trial results on catheter-based coronary procedures are presented.

The details

In the P4 trial, CCTA-guided PCI uses coronary computed tomography angiography to guide stent placement, while IVUS-guided PCI uses intravascular ultrasound inside the artery to guide it. In TRANSFORM II, patients with successfully prepared lesions were randomized to either a sirolimus-coated balloon, which delivers the drug directly to the artery wall during inflation without leaving a permanent implant, or an everolimus drug-eluting stent, which leaves a metal scaffold that releases the drug over time. Target-vessel and target-lesion failure measure repeat revascularization or other adverse events at the treated site.

Timeline

  1. TRANSFORM II enrolled patients between December 2021 and June 2025.

  2. P4 primary endpoint outcomes were measured at 12 months.

  3. TRANSFORM II net adverse clinical events were followed for one year.

  4. Both sets of results were presented at TCT 2026 on November 1, 2026.

Health Landscape

The findings add to the comparative evidence on how coronary stenting is guided and which devices are used in native coronary arteries. They sit within an ongoing effort to determine whether less invasive or alternative approaches can match established standards of care for treating coronary artery disease.

If you have coronary artery disease or are being evaluated for stenting, these findings are worth discussing with your cardiologist, who can explain which imaging approach and device options suit your situation. Population-level results like these do not predict individual outcomes, so personal treatment decisions should be made with your physician.

The takeaway

Both trials found outcomes that were comparable to established approaches, not clearly better, in the populations studied. Ask your cardiologist which imaging guidance and stent options are appropriate for your coronary condition.

Further reading

For broader context on treatment approaches, explore our Heart Disease coverage.