Geographic miss with aorto-ostial coronary stent implantation: insights from high-resolution coronary computed tomography angiography

Rubinshtein, Ronen; Ben–Dov, Nissan; Halon, David A.; Lavi, Idit; Finkelstein, Ariel; Lewis, Basil S.; Jaffe, Ronen

doi:10.4244/eijv11i3a57

Cited by 20 publications

(11 citation statements)

References 17 publications

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“…Also, ultrasound guidance for stent placement has been associated with better outcomes [10,15]. This effect on outcomes may be explained by the ability of IVUS to reduce geographical miss, whereas two-dimensional angiography frequently does not result in complete lesion coverage [16]. Therefore, routine use of IVUS in aorto-ostial lesions should be considered.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes after Additional Dynamic Renal® Stent Implantation for Stent Recoil in Ostial Coronary Lesions

Abdulrahman¹,

Mashayekhi²,

Tajti³

et al. 2020

JCM

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Background: Interventional treatment of aorto-ostial coronary stenoses is limited by stent recoil and suboptimal angiographic results, leading to restenosis and frequent re-interventions. As a potential bail-out strategy for stent recoil, implantation of an additional stent to increase radial force has been reported. Thus, we sought to investigate clinical outcomes after additional implantation of a Dynamic Renal® stent (DRS), a non-coronary; bare-metal stent with very high radial force, in aorto-ostial coronary stenoses. Methods: Patients treated by implantation of DRSs for stent recoil in the ostial right coronary artery or the left main stem were identified from the hospital database. Baseline clinical and procedural characteristics were compared to patients who underwent re-intervention for in-stent-restenosis in similar segments by either implantation of conventional drug-eluting stents (DES) or paclitaxel-coated balloons (PCB). Clinical follow-ups were performed up to three years following re-intervention with the assessment of death, target lesion reintervention (TLR), and major adverse cardiac events (MACE) as a combination death, myocardial infarction and target vessel revascularization. Kaplan–Meier analyses were performed for event-free survival between the three groups. Results: Between 05/2013 and 07/2019, 28 patients underwent DRS implantation of aorto-ostial coronary lesions. In comparison with 49 patients with DES implantation and 29 patients undergoing PCB treatment, no relevant differences in baseline parameters were identified. Median follow-up was 714 days, with an available follow-up of >1 year after intervention in 82.1% of patients. In the entire study cohort at two years after re-intervention, the TLR rate was 16% (17 patients), the MACE rate 37% (39 patients), and all-cause mortality 9% (10 patients), with no significant differences between the three groups. Conclusions: DRS implantation for treating stent recoil of aorto-ostial coronary lesions resulted in a high rate of TLR, and was associated with similar risk for death and MACE compared to treatment of in-stent-restenosis with DES or PCB. Randomized, larger comparisons of contemporary DES in patients exclusively presenting with stent recoil are necessary to further define the efficacy and safety of this approach.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes after Additional Dynamic Renal® Stent Implantation for Stent Recoil in Ostial Coronary Lesions

Abdulrahman¹,

Mashayekhi²,

Tajti³

et al. 2020

JCM

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“…6A, B ). In one short series of patients after LM stenting, control MSCT revealed that the stent had been implanted optimally in relation to the ostium only in 3 out of 23 cases [ 5 ]. The precise positioning of stents in the coronary ostia is of paramount importance because it can substantially affect long-term clinical success.…”

Section: Discussionmentioning

confidence: 99%

“…The gap results partly from differences in the plaque composition, which is more rigid, calcified, and bulky in the case of AOL [ 3 , 4 ]. A lot of target lesion failures are due to technical problems during the procedure, resulting in overly deep stent implantation and incomplete coverage of the treated lesion [ 5 ]. On the other hand, excessive protrusion of the stent into the aorta also has negative consequences because it can hinder re-engagement of the vessel with the catheter or seriously complicate subsequent interventions on the aortic valve [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Optimal fluoroscopic viewing angles for stenting of the coronary aorto-ostial lesions

et al. 2021

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Background: Long-term results after stenting aorto-coronary ostial lesions (AOL) are worse than those achieved in non-ostial locations. AOL interventions still pose a substantial challenge for interventional cardiologists. The aim of the study was to determine the optimal fluoroscopic viewing angles of the left and right coronary ostia, based on multislice computed tomography (MSCT) data.Methods: Cardiac MSCT exams of 30 patients with clinical suspicion of coronary artery disease were analyzed. En face angles of both coronary ostia, as well as their optimal projection curves, were determined by 2 independent observers in a standard Dicom viewer, without any additional, specialized software add-ons, using a systematic, step-by-step approach. Spatial relations between the ostial plane and the aorta were also assessed. Results:The average en face angle of the left coronary ostium was RAO 23°, CAU 45°; for the right coronary ostium RAO 18°, CRA 5°. The mean inter-observer differences for the en face angles of the left and right coronary arteries were 5 and 7, respectively. Conclusion:Multislice computed tomography data provide precise spatial information on the orientation of the coronary ostia and their relation to the aortic root. Their utilization for determining the patient-specific viewing angle may substantially facilitate percutaneous coronary interventions in AOL.

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“…The follow‐up results showed that stent mispositioning was associated with a significantly higher ISR and TLR compared to patients with accurate stent placement. Rubinshtein et al performed postoperative CCTA in patients with aorto‐ostial stenosis and found that the incidence of inaccurate stent placement was 87.00%, of which 40.00% were closely related to the techniques. Timurkaynak et al used the draw‐back technique for the accurate localization of LAD ostial lesions.…”

Section: Discussionmentioning

confidence: 99%

A 3‐year experience of a simple, novel technique for accurate ostial/non‐ostial coronary stenting: The buddy balloon anchor stent technique

Chen¹,

Lu²,

Song

et al. 2018

Cathet Cardio Intervent

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Geographic miss with aorto-ostial coronary stent implantation: insights from high-resolution coronary computed tomography angiography

Abstract: Geographic miss was common in aorto-ostial stenting and was underestimated by conventional two-dimensional angiography.

Cited by 20 publications

References 17 publications

Clinical Outcomes after Additional Dynamic Renal® Stent Implantation for Stent Recoil in Ostial Coronary Lesions

Clinical Outcomes after Additional Dynamic Renal® Stent Implantation for Stent Recoil in Ostial Coronary Lesions

Optimal fluoroscopic viewing angles for stenting of the coronary aorto-ostial lesions

A 3‐year experience of a simple, novel technique for accurate ostial/non‐ostial coronary stenting: The buddy balloon anchor stent technique

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