Vulnerable Carina Anatomy and Ostial Lesions in the Left Anterior Descending Coronary Artery After Floating-Stent Treatment

Introduction and objectives. 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.