J Cardiovasc Interv.  2022 Oct;1(4):151-157. 10.54912/jci.2022.0014.

Optimal Technique for Ostial Left Anterior Descending Coronary Artery Lesion

• Yun KH
• Cho JY
• Lee SY
• Oh SK

• KMID: 2561254
• DOI: http://doi.org/10.54912/jci.2022.0014

Abstract

Ostial lesion of left anterior descending coronary artery (LAD) is a unique lesion subset often leading to a complex percutaneous coronary intervention. After the introduction of drug eluting stents (DESs), the crossover stenting technique has been considered as a reasonable treatment strategy for the ostial LAD lesion. However, there is a dearth of clinical studies systemically comparing ostial stenting and crossover stenting. Only 5 retrospective observational studies regarding DES were published as of July 2022. All studies demonstrated that target lesion revascularization rate tended to be higher in ostial stenting than crossover stenting. Safety profiles such as cardiac death or myocardial infarction were similar between the 2 techniques. Patients showed better outcomes when intravascular imaging and proximal optimization technique (POT) were used than when they were not used. In conclusion, intravascular imaging and crossover stenting followed by POT may be an optimal approach for the treatment of most ostial LAD lesions based on available data. That being said, treatment strategies need to be adjusted in careful consideration of various clinical situations.

Keyword

Percutaneous coronary intervention; Coronary stenosis; Drug-eluting stents