title: High incidence of inaccurate stent placement in the treatment of coronary aorto-ostial disease.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the incidence of inaccurate stent positioning in the treatment of coronary aorto-ostial lesions.
  
  
  BACKGROUND
  The percutaneous treatment of aorto-ostial disease is challenging, with a paucity of data describing the incidence of stent mispositioning.
  
  
  METHODS
  We retrospectively reviewed the accuracy of stent positioning in 100 consecutive coronary aorto-ostial lesions. Using careful angiographic review, each stent placement was classified as "missed" (> 1 mm distal or proximal to the angiographically determined ostium) or "accurately" positioned.
  
  
  RESULTS
  The true ostium was missed during stent placement in 54% of cases. In 52% of the misses, the stent was placed too proximally. This proximal miss was associated with an inability to coaxially re-engage the treated vessel in 93% of the cases. The stent was placed too distally in 48% of missed cases, resulting in a placement of one or more additional overlapping stents in 38% of those cases. Clinical follow-up (mean, 24.5 ± 12.9 months) was obtained in 98% of cases. Angiographic follow-up prompted by recurrent chest pain or ischemia was performed in 45/100 cases. There was a three-fold increase in restenosis and target lesion revascularization (TLR) among the cohort of patients with stent misplacement (26% and 23%, respectively) compared to those with accurate stent placement (9% and 6%, respectively; p = 0.02 for both restenosis and TLR).
  
  
  CONCLUSIONS
  Angiographically-guided stenting for coronary aorto-ostial disease leads to a high incidence of proximal and distal stent misplacement. Stent mispositioning is associated with significantly higher restenosis and clinically driven TLR compared to patients with accurate stent placement.
authors.affiliation: Michigan State University, Borgess Heart Institute, Kalamazoo, MI 49048, USA.
authors.forename: Dwight A
authors.initials: DA
authors.lastname: Dishmon
authors.forename: Adam
authors.initials: A
authors.lastname: Elhaddi
authors.forename: Kevin
authors.initials: K
authors.lastname: Packard
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.forename: Tim A
authors.initials: TA
authors.lastname: Fischell
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019300:Medical Errors / Q000009:adverse effects* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome