Author(s): Dishmon DA, Elhaddi A, Packard K, Gupta V, Fischell TA
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Abstract OBJECTIVES: The purpose of this study was to evaluate the incidence of inaccurate stent positioning in the treatment of coronary aorto-ostial lesions. BACKGROUND: The percutaneous treatment of aorto-ostial disease is challenging, with a paucity of data describing the incidence of stent mispositioning. METHODS: We retrospectively reviewed the accuracy of stent positioning in 100 consecutive coronary aorto-ostial lesions. Using careful angiographic review, each stent placement was classified as "missed" (> 1 mm distal or proximal to the angiographically determined ostium) or "accurately" positioned. RESULTS: The true ostium was missed during stent placement in 54\% of cases. In 52\% of the misses, the stent was placed too proximally. This proximal miss was associated with an inability to coaxially re-engage the treated vessel in 93\% of the cases. The stent was placed too distally in 48\% of missed cases, resulting in a placement of one or more additional overlapping stents in 38\% of those cases. Clinical follow-up (mean, 24.5 ± 12.9 months) was obtained in 98\% of cases. Angiographic follow-up prompted by recurrent chest pain or ischemia was performed in 45/100 cases. There was a three-fold increase in restenosis and target lesion revascularization (TLR) among the cohort of patients with stent misplacement (26\% and 23\%, respectively) compared to those with accurate stent placement (9\% and 6\%, respectively; p = 0.02 for both restenosis and TLR). CONCLUSIONS: Angiographically-guided stenting for coronary aorto-ostial disease leads to a high incidence of proximal and distal stent misplacement. Stent mispositioning is associated with significantly higher restenosis and clinically driven TLR compared to patients with accurate stent placement.
This article was published in J Invasive Cardiol
and referenced in Journal of Vascular Medicine & Surgery