Long-term clinical efficacy of ostial stenting to the left anterior descending artery with deep caudal projection

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Purpose: Overlapping and foreshortening on conventional coronary angiography is one reason why the presence of ostial lesions in the left anterior descending artery (LAD) is an independent predictor of insegment restenosis. Our previous study using 3-dimensional reconstruction coronary angiography demonstrated the superiority of a deeper caudal projection in clearly showing the ostium of the LAD compared to the standard right or left anterior oblique caudal view. Therefore, the aim of this study was to determine the short-and long-term efficacy of the ostial stenting technique using a deep caudal projection angle. Methods: A total of 30 consecutive patients who underwent stent deployment to treat LAD lesions positioned at the proximal edge of the stent in the ostium with a deep caudal projection were analyzed retrospectively. Results: The projection of right anterior oblique caudal 40° was used in 26 patients and that of left anterior oblique caudal 40° was used in four patients. Intravascular ultrasound examinations showed complete coverage of the ostium by the stent in 29 patients. In one patient, the stent did not cover the ostium. The mean protrusion of the stent over the ostium was 0.66 ± 0.85 mm. During the follow-up period (1203.5 [982-1329] days), the rate of target lesion failure was 16.7%, and there were no cases with in-stent restenosis of the main branch in which a drug-eluting stent covering the ostium of the LAD was successfully deployed. Conclusions: Focal stent placement using a deep caudal projection is a feasible and effective therapeutic strategy for treating ostial lesions in the LAD.