Real‐time intravascular ultrasound guidance: A novel technique for accurate placement of ostial stents

Abstract

Objectives: To describe a novel technique for ostial stent placement using real-time IVUS guidance.Background: Accurate placement of coronary stents at ostial locations is challenging with the true ostium frequently being missed increasing the risk of adverse events.We have developed a novel technique for ostial stent placement and report our benchtop testing and initial clinical experience.Methods: Benchtop testing was performed to validate the appearance of the stent and delivery system on IVUS. Benchtop testing of real-time IVUS guided ostial stent positioning was carried out in a left main bifurcation phantom. Realtime IVUS guidance of stent placement in aorto-ostial, ostial left anterior descending (LAD), or ostial circumflex lesions was assessed in a prospective registry.Results: Bench model IVUS demonstrated clear differences between the appearances of the stent and other components of the delivery system.Positioning of 10 consecutive stents into the ostial LAD using real-time IVUS guidance was assessed in a left main bifurcation model. Median distance from proximal stent edge to LAD ostium was 0.39 mm (interquartile range 0.31 to 0.73). Real-time IVUS guidance of ostial stent placement was performed in 50 patients (51 lesions). Angiographic success was 100%. IVUS post-stenting demonstrated median distance from the proximal stent edge to the ostium was 0.2 mm (interquartile range 0.1 to 0.5 mm). There was one periprocedural myocardial infarction but no other major adverse cardiac events at 30-days. Conclusions:We have developed a novel technique using real-time IVUS guidance allowing accurate ostial stent placement.

Comparison between a dedicated stent positioning system and conventional stenting of aorto-ostial lesions: a prospective, multi-center, randomized controlled study

“…Harding et al described a novel technique to guide stent placement in coronary AOLs. An intravenous ultrasound (IVUS) catheter placed over a floating coronary guidewire in the aorta allowed real-time IVUS imaging and guidance of stent positioning at the ostium ( 20 ). Both benchtop testing and a clinical case series have demonstrated that this technique may allow precise stent placement in AOLs.…”

The Use of Bumper Wire Technique and Intravascular Ultrasound for Precise Aorto-Ostial Stenting

“…This is a retrospective, single-center experience, and, therefore, commonly recognized shortcomings of these two aspects should be acknowledged. While this study is one of few to include both left and right coronary interventions, evidence for use of the bumper wire technique in ostial graft interventions is still lacking ( 24 , 25 ). This study did not utilize a comparator group due to a lack of equipoise among operators, thus, limiting the interpretation of observed clinical outcomes without a reference population.…”

First Experience Using the Sheathless Hyperion Guiding Catheter System Designed for Direct Insertion

“…The large inner lumen particularly of the 7F SHGC is compatible with a wide range of equipment and techniques. The 7 F SHGC can accommodate a rotational atherectomy burr up to 2.0 mm in size, IVUS with a low-profile microcatheter facilitating real-time visualisation and puncture of a proximal CTO cap, and a low-profile IVUS alongside a stent allowing real-time IVUS-guided ostial stent placement [ 17 ]. The combination of Henka Braid and Hyper Shaft technology and improved shapes in the SHGC has increased the manoeuvrability and backup when compared to the sheathless Eaucath.…”