The incidence of stent placement “error” with stenting of coronary aorto-ostial disease

Dishmon, Dwight A.

doi:10.1016/j.carrev.2011.04.268

Cited by 22 publications

(41 citation statements)

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“…MSA at least > 6.5 mm 2 for BMSs and > 5.0 mm 2 for DESs 2. MSA > 90% of the distal reference lumen area or > 80% of average reference lumen area 3. lack of major dissections, intramural hematomas, and geographic misses Criteria for accuracy of stent location by IVUS and SBS 6) (A stent "misplacement" was defined as the stent being deployed > 1 mm proximal or distal to the true ostium. )…”

Section: Resultsmentioning

confidence: 99%

“…However, it was reported that angiographically-guided stenting for coronary ostial disease leads to a high incidence of proximal and distal stent misplacement. 6) In aorto-ostial lesions in particular, the guiding catheter is often slightly engaged into the target vessel, so angiography could not clearly show the location of the stent ( Figure 3A).…”

Section: Discussionmentioning

confidence: 99%

“…5) Complete stent coverage of ostial lesions can be problematic, with inaccurate stent placement leading to higher rates of restenosis. 6) Compared with coronary angiography, intravascular ultrasound (IVUS) allows for a more detailed assessment of coronary anatomy, including plaque characteristics and morphology, vessel size, and precise localization of the true ostium. 7) The only reliable way to exclude insufficient stent deployment with certainty is IVUS.…”

Section: P Ercutaneous Coronary Intervention (Pci) Of Coronary Os-mentioning

confidence: 99%

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Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

et al. 2015

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SummaryPercutaneous coronary intervention (PCI) of ostial lesions is complex and is technically very demanding. Intravascular ultrasound (IVUS) is considered the gold standard method to guide PCI but has several limitations. Stent boost subtract (SBS) imaging is an enhancement of the radiologic edge of the stent by digital management of regular X-ray images. The purpose of this study was to determine the availability of stent enhancement with SBS during ostial PCI by comparison with IVUS.We investigated SBS and IVUS after stent implantation in 58 ostial lesions in 55 patients. SBS and IVUS were performed in all patients to obtain improved stent location and to detect optimal release and deployment. We defined the SBS and IVUS criteria for accuracy of stent location and adequate stent deployment. IVUS findings showed that stent location was generally good. The location was accurate in 48 (82.8%) and inadequate stent deployment was observed in 10 of 58 (17.2%). Eight SBS images showed inadequate stent expansion. SBS predicted inadequate findings of IVUS with 100% specificity and 80% sensitivity, while a significant positive correlation was observed between SBS-MSA and MSA by IVUS with a regression coefficient of 0.95.Imaging techniques have a primary role during ostial PCI. SBS is a simple and quick method that offers several advantages, enabling improved stent location, adequate stent expansion, and optimal apposition of the struts to the wall. SBS imaging could be conventionally used during ostial PCI, especially in centers where IVUS is not used routinely. (Int Heart J 2015; 56: 37-42) Key words: Percutaneous coronary intervention, Apposition, Stent location, Stent expansion P ercutaneous coronary intervention (PCI) of coronary ostial lesions is technically difficult leading to higher rates of adverse cardiac events compared with PCI of non-ostial coronary lesions.1-4) The challenges of PCI of an ostial lesion may depend not only upon the lesion location (ie, aorto-ostial versus non-aorto-ostial), but also on the plaque burden and lesion morphology. Ostial lesions are less compliant compared with non-ostial lesions due to increased fibrosis, calcification, and muscular/elastic tissue, the latter of which is especially evident in aorto-ostial disease.5) Complete stent coverage of ostial lesions can be problematic, with inaccurate stent placement leading to higher rates of restenosis. 6) Compared with coronary angiography, intravascular ultrasound (IVUS) allows for a more detailed assessment of coronary anatomy, including plaque characteristics and morphology, vessel size, and precise localization of the true ostium.7) The only reliable way to exclude insufficient stent deployment with certainty is IVUS.8-10) However, in daily practice, this technique is not used routinely because it is expensive, time-consuming, and there is a learning curve (requiring trained operators and laboratory staff).11) Moreover, it is difficult to obtain an accurate location of the stent before the stent is released. Stent boost sub...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: P Ercutaneous Coronary Intervention (Pci) Of Coronary Os-mentioning

confidence: 99%

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Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

et al. 2015

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“…PCI for an ostial lesion of an anomalous LCX originating from the LCC is challenging because it is difficult to correctly determine the position of the ostium. Complete stent coverage is needed for an aorto-ostial lesion because of high restenosis rates [5]. IVUS is effective for an ostial lesion; a previous report showed the accurate stent position for a left main ostial lesion [6].…”

Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound guided Percutaneous Coronary Intervention for the Ostial Lesion of the Anomalous Left Circumflex Artery Originated from Left Coronary Cusp Directly

Kuno¹,

Hashimoto²

2016

Angiol

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Percutaneous coronary intervention (PCI) for the ostial lesion of the anomalous left circumflex artery (LCX) originating from the left coronary cusp is challenging because of the difficulty in correctly determining the position of the ostium. This report examines the case of an 81-year-old man with a non-ST segment elevation myocardial infarction with an anomalous LCX origin. An angiography showed the diffuse plaque including the ostium. After successfully engaging an Amplatz-Left guiding catheter and observing the lesion with intravascular ultrasound (IVUS), we dilated the vessel with a balloon. Since we needed to implant the stent to cover the ostial lesion, we used IVUS in combination with angiography to correctly determine the position of the ostium. The stent was implanted successfully and, to our knowledge, this is the first case report of PCI for the separated ostium of the anomalous LCX originating from the left coronary cusp, including the ostial lesion. We also present the IVUS images of both the left anterior descending artery and the LCX.

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“…All this typically requires closer attention, frequently with larger image intensification, more fluoroscopy, and perhaps one of the reported approaches to delivery [1][2][3][4][5]. First, we must be certain that a lesion truly exists and is not related to catheter-induced spasm or an angiographic over read.…”

mentioning

confidence: 99%

Generations: The old gives way to the new, and the new is too soon the old

Butman

2015

Cathet Cardio Intervent

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The incidence of stent placement “error” with stenting of coronary aorto-ostial disease

Cited by 22 publications

References 0 publications

Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

Stent Boost Subtract Imaging for the Assessment of Optimal Stent Deployment in Coronary Ostial Lesion Intervention

Intravascular Ultrasound guided Percutaneous Coronary Intervention for the Ostial Lesion of the Anomalous Left Circumflex Artery Originated from Left Coronary Cusp Directly

Generations: The old gives way to the new, and the new is too soon the old

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