Geographic miss with aorto-ostial coronary stent implantation: insights from high-resolution coronary computed tomography angiography.
OBJECTIVE
Accurate positioning of aorto-ostial coronary stents is challenging. Coronary CT angiography (CCTA) allows detailed imaging of the coronary sinuses and implanted stents. We utilised CCTA to evaluate the accuracy of aorto-ostial stenting and to assess the efficacy of conventional angiography for guiding these procedures.


RESULTS
We analysed 256-row CCTA scans in 23 patients who had undergone aorto-ostial stenting. Optimal stent positioning was defined as presence of the entire circumference of the proximal stent edge within an aorto-ostial landing zone (AOLZ), located within 1 mm of the aorto-ostial plane. Geographic miss was diagnosed when at least a section of the proximal stent edge was located proximal or distal to the AOLZ. CCTA findings were compared with review of the conventional two-dimensional implantation angiogram (two experienced operators). By CCTA, the entire circumference of the proximal stent edge was located within the AOLZ in only three (13%) cases, with geographic miss in the remainder. Conversely, conventional coronary angiography suggested complete lesion coverage to be present in 95% of cases and optimal location of the proximal stent edge within the AOLZ in 76%.


CONCLUSIONS
Geographic miss was common in aorto-ostial stenting and was underestimated by conventional two-dimensional angiography.
Cardiology Department, Lady Davis Carmel Medical Center, Haifa, Israel.
Ronen
R
Rubinshtein
Nissan
N
Ben-Dov
David A
DA
Halon
Idit
I
Lavi
Ariel
A
Finkelstein
Basil S
BS
Lewis
Ronen
R
Jaffe
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome