Dr.S.Venkatesan MD

Tackling ostial LAD lesions : A new technique

June 23, 2010 3:32 pm

Bifurcation lesions and ostial lesions continue to challenge the expertise of interventional cardiologists.

Variety of techniques have been described. Geo positioning of a ostial lesions , exactly on the rim of ostium is required . This is very difficult in many patients , as stent migration either into side branch or protrusion into the main branch is common. Both reduce optimal PCI outcome .

Here is a innovative technique described first by Szab0 in 2005 TCT conference .

Highlights of the technique

It is a twin guide wire technique.
The Circumflex guide wire is threaded over the most proximal strut of balloon mounted LAD stent .
The guidewire makes sure the LAD stent move beyond the LAD ostium .
Of course some technical limitation is there, this seems to be a good option at least in some deserving LAD ostial or LCX ostial lesions

Technical hitch

The balloon and stent is to be manhandled prior to deployment. We are little awry to do it