Ostial lesions

Summary

The treatment of ostial stenosis by percutaneous techniques has been associated with lower procedural success rates, more frequent in-hospital complications and a greater likelihood of restenosis when compared with non-ostial stenoses. While indications for PCI of ostial lesions, in principle, follow the same considerations as those for other coronary lesions, namely, lesion assessment, material selection and interventional strategy, a precise knowledge of the anatomy and physiology of ostial lesions is required to obtain the best possible interventional result.

Ostial lesions are frequently rigid and heavily calcified, which may lead to incomplete stent expansion and thus may require preparation with debulking techniques. Complications prone to occur in ostial lesion PCI include dissections of the vessel (which often are caused by aggressive or unintentional guide catheter manipulation), or, the loss of guide catheter position due to insufficient support.

Specific ostial intervention techniques include the so-called draw-back stent deployment technique and the tail-wire or Szabo-technique. These manoeuvres may be helpful to achieve precise coverage of the ostium without excessive protrusion into the aorta or the respective main vessel.

Introduction

Lesions within 3 mm from the origin of a coronary vessel are classified as ostial lesions. A distinction can...