In a prospective randomized trial, 64 patients undergoing CT angiography (CTA) prior to transcatheter aortic valve implantation (TAVI) were randomly assigned to one of two imaging protocols. Group A (37 patients) received a thoracic ECG-gated scan followed by a non-gated helical scan of the abdomen and pelvis. Group B (27 patients) underwent an ECG-gated scan limited to the heart and aortic root, followed by a non-gated helical scan encompassing the thorax, abdomen, and pelvis. Both subjective and objective comparisons between the two protocols were conducted by two radiologists. Objective analysis included vascular attenuation, contrast-to-noise ratio and signal-to-noise ratio. The results demonstrated that group B received a significantly lower volume of contrast medium and a reduced radiation dose compared with group A (p < 0.001), while maintaining comparable aortic root lumen attenuation (p = 0.077). This optimized pre-TAVI CTA protocol provides a safe imaging alternative that preserves diagnostic image quality while minimizing patient contrast and radiation exposure.