Vulnerable carina anatomy and ostial lesions in the left anterior descending coronary artery after floating-stent treatment.
OBJECTIVE
Percutaneous coronary intervention for ostial lesions of the left anterior descending coronary artery (LAD) remains a complex procedure. The aim of this study was to evaluate the usefulness of a method of treatment that we have termed the floating-stent approach.


METHODS
The study involved 71 patients with ostial LAD lesions who underwent implantation of a drug-eluting stent in the LAD, which totally or partially covered the ostium of the circumflex artery. No further interventions were planned. Intravascular ultrasound was performed both at baseline and after treatment in 49 patients. All were followed up clinically (16+/-12 months).


RESULTS
Angiography of the LAD demonstrated an immediate success rate of 100%. However, significant focal damage was observed in the circumflex ostium in 7 (10%) patients, three of whom needed treatment. The mean protrusion of the stent over the origin of the circumflex artery was 2.48+/-0.91 mm. The only predictor of circumflex ostial injury identified in the study was the carina having a spiky appearance on intravascular ultrasound, visible in the longitudinal view. We termed this feature the "eyebrow sign". Carina displacement was responsible for the focal damage in 13 of the 14 patient with this feature. Overall, the major cardiac adverse event rate during follow-up was 4%.


CONCLUSIONS
Use of the floating-stent technique for treating LAD ostial lesions was straightforward and gave excellent medium-term


RESULTS
Intravascular ultrasound showed that patients who had a carina with specific vulnerable anatomical features were predisposed to circumflex artery ostial injury.
Medina
Alfonso
A
Servicio de Cardiología, Hospital Doctor Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
Martín
Pedro
P
Suárez de Lezo
Javier
J
Amador
Celestina
C
Suárez de Lezo
José
J
Pan
Manuel
M
Melián
Francisco
F
Hernández
Enrique
E
Burgos
Luis
L
Ojeda
Soledad
S
Ortega
José Ramón
JR
García
Antonio
A
D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D014463:Ultrasonography