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  • Title: High incidence of inaccurate stent placement in the treatment of coronary aorto-ostial disease.
    Author: Dishmon DA, Elhaddi A, Packard K, Gupta V, Fischell TA.
    Journal: J Invasive Cardiol; 2011 Aug; 23(8):322-6. PubMed ID: 21828393.
    Abstract:
    OBJECTIVES: 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.
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