Ostial Left Anterior Descending Artery Research Articles

Optimal Percutaneous Treatment Approach to Unprotected Ostial Left Anterior Descending Artery Disease: A Meta-Analysis and Systematic Review

The optimal management strategy for significant unprotected ostial left anterior descending artery (LAD) disease remains undefined. Merits of the two most common percutaneous approaches are considered in this quantitative synthesis. A meta-analysis was performed to compare ostial stenting (OS) and crossover stenting (CS) in the treatment of unprotected ostial LAD stenosis. The primary outcome is the disparity in target lesion revascularisation (TLR). The Mantel-Haenszel method was employed with random effect model, chosen a priori to account for heterogeneity among the included studies. Seven studies comprising 1,181 patients were included in the analyses. Of these, 482 (40.8%) patients underwent CS. Overall, there was a statistically significant trend in favour of CS (odds ratio 0.51, 95% confidence interval 0.30-0.86, p=0.01) with respect to the rate of TLR at follow-up. This remained true when TLR involving the left circumflex artery (LCx) was considered, even when there was a greater need for unintended intervention to the LCx during the index procedure (odds ratio 6.68, 95% confidence interval: 1.69-26.49, p=0.007). Final kissing balloon inflation may reduce the need for acute LCx intervention. Imaging guidance appeared to improve clinical outcomes irrespective of approach chosen. In the percutaneous management of unprotected ostial LAD disease, CS into the left main coronary artery (LMCA) appeared to reduce future TLR. Integration of intracoronary imaging was pivotal to procedural success. The higher incidence of unintended LCx intervention in the CS arm may be mitigated by routine final kissing balloon inflation, although the long-term implication of this remains unclear. In the absence of randomised trials, clinicians' discretion remains critical.

TCTAP C-061 Challenges of Short Left Main With Ostial Left Anterior Descending Artery Lesion Intervention

TCTAP C-061 Challenges of Short Left Main With Ostial Left Anterior Descending Artery Lesion Intervention

Clinical Outcome of Intravascular Ultrasound Guided Percutaneous Coronary Intervention of Isolated Ostial Left Anterior Descending Artery Lesions

Purpose: Despite recent advances in interventional cardiology procedures, isolated ostial left anterior descending (LAD) lesions remain a challenge in cardiology. Due to the probability of left main (LM) affection, an LM bifurcation stenting technique may be required in certain individuals. So we evaluated result of Intravascular Ultrasound (IVUS) guided percutaneous coronary intervention (PCI) in isolated LAD coronary artery lesions, either by crossing over the ostium or not, with a focus on major adverse cardiovascular events (MACE).
 Methodology: Our prospective study from January2021 to November 2022 included 79 isolated ostial LAD patients with Ostial LAD stenting (OS) or LM to LAD cross-over (CO) stenting at the National Heart Institute. As per the recommended guidelines, the participants were divided into two groups: the first one had IVUS guided PCI and Group (2) had Angiography guided PCI. The data was collected and statistically analyzed with SPSS 23.0 program.
 Findings: No statistically significant difference was present between the groups regarding socio-demographic or clinical data (P-value > 0.05). It was discovered that an increase in Rotablator use, a decrease in Fluoroscopy time (min), a decrease in Contrast volume (ml), and a decrease in PCI duration (min) in patients who had IVUS guided PCI, with statistically significant difference when compared to other group who had Angiography guided PCI (P-value < 0.05). In addition, it was discovered that an increase in the necessity for a cross-over stenting method in group (1), with no statistically significant difference (P-value > 0.05). High prevalence of mortality and morbidity among IVUS guided PCI patients was present with statistical significance regarding TVR (P-value < 0.05).
 Recommendations: IVUS can offer valuable information on vascular lumen, plaque features, stent deployment, & device failure causes. As a result, IVUS-guided PCI may enhance clinical impact among participants, particularly those with complicated coronary lesions & those at high risk. Further reduction in IVUS’s cost, cardiologists’ education and enhancing IVUS use at PCI should be adapted next.

Technical Feasibility and Safety of Percutaneous Coronary Intervention for True Ostial Left Anterior Descending Artery–Chronic Total Occlusion

BackgroundPercutaneous coronary intervention (PCI) for true ostial left anterior descending artery (LAD)–chronic total occlusion (CTO) lesions poses technical challenges owing to its inherent anatomic features. MethodsIn total, 270 consecutive patients who underwent PCI for ostial LAD-CTO at 13 major cardiac centers in South Korea were included. Ostial LAD-CTO was strictly defined as a LAD-CTO lesion whose proximal cap was within 1 mm from the carina of the distal left main coronary artery (LMCA) bifurcation. ResultsOstial LAD-CTOs were frequently accompanied by stumpless lesion entry (43.4%), whereas significant bending within the occluded segment was less frequent (14.4%). The overall technical success rate was 85.9%, and serious in-hospital adverse events occurred in 5.6%. The retrograde approach tended to contribute more frequently to success in patients with concomitant LMCA disease, stumpless CTO, interventional collaterals, and higher Japanese-CTO scores. Apparent dissection or hematoma requiring rescue procedure at the LMCA or left circumflex artery occurred in 14 patients (5.2%), with a higher tendency in patients who had LMCA disease (12.1% vs 4.2%) and stumpless entry (9.4% vs 2.0%) than in those without. Among patients who were successfully treated, with an average of 1.7 stents, target-vessel failure occurred in 23 patients (9.9%) during a median 3.3 years of follow-up. ConclusionsIn this first large-scale analysis of true ostial LAD-CTO, PCI was feasible with a high technical success rate and favourable mid-term outcomes. Clinically relevant inflow vessel injury can occur during PCI and should be an important technical consideration regarding safety.

TCTAP C-217 Danger in Plain Sight: Ostial Left Anterior Descending Artery Injury During Ablation of Left Ventricular Summit Premature Ventricular Complex

### Patient Initials or Identifier Number NSI ### Relevant Clinical History and Physical Exam We described a 25-year-old patient without past medical history who was electively admitted for premature ventricular complex (PVC) ablation. She initially presented with frequent palpitation and

TCT-834 Comparison of Two-Year Clinical Outcomes Between Ostial Stenting and Crossover Stenting for Ostial Left Anterior Descending Artery Lesions

Recently, stent implantation for ostial left anterior descending coronary artery (LAD) lesions has become a common clinical practice; however, the efficacy and safety of LAD ostial stenting (OS) and distal left main coronary artery (LMCA) to LAD crossover stenting (CS) is not well known. A total of

Unintentional Extraction of Previously Deployed Stent in Ostial Left Anterior Descending Artery during a Dislodged Left Main Stent Retrieval

Unintentional Extraction of Previously Deployed Stent in Ostial Left Anterior Descending Artery during a Dislodged Left Main Stent Retrieval

TCTAP C-076 Percutaneous Coronary Intervention for Stumpless Ostial Left Anterior Descending Artery Chronic Total Occlusion with Poor Developed Collateral Connection

### Patient initials or identifier number DT ### Relevant clinical history and physical exam A 45-year-old man with exertional dysnea of 2 months duration refractory to maximal medical therapy. The past cardiac history was significant for PCI 13 years previously, including a bare metal stent

TCTAP C-107 Massive Spiral Dissection of Left Main and Circumflex Artery in Antegrade Recanalization of Chronic Total Occlusion of Ostial Left Anterior Descending Artery

TCTAP C-107 Massive Spiral Dissection of Left Main and Circumflex Artery in Antegrade Recanalization of Chronic Total Occlusion of Ostial Left Anterior Descending Artery

Efficacy of Drug-Eluting Balloon in the Treatment of Ostial Left Anterior Descending Artery In-Stent Restenosis

Percutaneous coronary intervention with drug-eluting balloons has emerged as an adjunctive strategy in the setting of Interventional Cardiology. When compared to drug-eluting stents, drug-eluting balloons offer advantages such as immediate and homogeneous drug release in the arterial wall, absence of polymers that can induce chronic inflammatory reactions, and the potential for using dual antiplatelet therapy for a shorter period of time. Furthermore, in some situations, additional stenting is not desirable, which turns this modality into an interesting option. We report the case of a patient with acute coronary syndrome in whom this intervention was chosen to treat an ostial left anterior descending artery in-stent restenosis.

TCTAP A-052 The Predictors of Successful Percutaneous Coronary Intervention in Ostial Left Anterior Descending Artery Chronic Total Occlusion

TCTAP A-052 The Predictors of Successful Percutaneous Coronary Intervention in Ostial Left Anterior Descending Artery Chronic Total Occlusion

AS-144: Efficacy of Stent Placement at an Ostial Left Anterior Descending Artery Stenosis with a Deep Caudal Projection

Percutaneous coronary intervention in ostial lesions of the left anterior descending artery (LAD) remains challenging, even in the era of drug-eluting stents. We have investigated the optimization of the projection angle to clearly show the ostium of the LAD with 3-dimensional reconstruction of coronary angiography, and then the superiority of the deeper caudal projection to the standard right or left anterior oblique-caudal view was demonstrated. The aim of this study was to determine whether the deep caudal view is useful for the ostial stenting.

Long‐Term Clinical Efficacy of Cutting Balloon Angioplasty Followed by Bare Metal Stent Implantation for Treating Ostial Left Anterior Descending Artery Lesions

Drug-eluting stents (DES) are superior to bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions, but DES is not suitable for all patients in real life practice. We hypothesize that cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) for treating ostial LAD lesions is an alternative strategy. In our study, 101 consecutive patients (51 with DES and 50 with CBA + BMS) with ostial LAD stenting were included for retrospective investigation between November 2003 and May 2005. The target vessel diameter was > or =3.0 mm. We compared the DES group with the CBA + BMS group, the rates of restenosis (10.3% versus 17.9%, p = 0.386), target lesion revascularization (TLR) (5.88% versus 10%, p = 0.487) and major adverse cardiac events (MACE) (7.84% versus 12%, p = 0.525) were similar at 6-8 months angiographic follow-up, but there were higher bleeding events in the DES group (p = 0.033). During a 2-year clinical follow-up, no myocardial infarction occurred in the 2 groups, the rates of TLR (7.84% versus 10%, p = 0.741) and MACE (9.8% versus 12%, p = 0.723) were also similar. The MACE-free survival rate was 90.2% versus 88 % (p = 0.723). The CBA + BMS combination has a good long-term clinical effect in the treatment of ostial LAD lesions; it might be an alternative strategy for patients with contraindication for DES implantation, or patients who cannot endure long-term dual antiplatelet medication, or in elderly patients.