Two years experience of a simple technique of precise ostial coronary stenting

Objective: To evaluate a new technique of precise ostial coronary stenting without relying solely on angiography. Background: Precise stent positioning at ostial coronary stenosis is difficult because angiography may not be able to profile the coronary ostium, due to vessel overlap and/or foreshortening. This problem is compounded by bobbing or to and fro movement of the stent with cardiac contraction. Methods: A new technique of precise ostial stenting not dependant on angiography was utilized. A guidewire in a side branch was threaded through the most proximal stent cell and the stent was advanced into the target vessel until it was stopped at the carina. The stent was deployed and the side guidewire withdrawn. All results were documented by intravascular ultrasound (IVUS). Results: From October 2005 to October 2007, 58 patients with significant ostial coronary stenosis required stenting. Seventeen patients were treated in the conventional manner and the remaining 41 patients with the new technique. The ostial locations included 8 left main, 25 left anterior descending, 3 circumflex, 1 obtuse marginal, 3 right coronary, and 1 posterior descending artery. Success, as confirmed by IVUS, was achieved in 40 patients (97.6%). Failure occurred in a right coronary ostial stenosis, which was subsequently treated by the conventional method. There were no complications. Conclusion: This new technique is highly successful in cases of difficulty in stenting ostial stenosis guided solely by conventional angiography. (c) 2008 Wiley-Liss, Inc.