We sought to examine the prevalence, angiographic presentation, and procedural outcomes of ostial (side-branch ostial and aorto-ostial) CTOs among 1000 CTO percutaneous coronary interventions (PCIs) performed in 971 patients between 20 at 14 centres in the US, Europe, and Russia. Ostial chronic total occlusions (CTOs) can be challenging to recanalize. The patient has given informed consent for the publication of this manuscript. Attempts at repeat intervention of the RCA for ostial ISR with excessive stent overhang, can prove to be challenging due to the inability to engage the central stent lumen or Ethics PCI for ostial RCA disease is associated with higher rates of ISR. This review highlights the practical challenges encountered during PCI for the treatment of aorto-ostial stenoses of the RCA, particularly the importance of accurate initial stent placement to minimise subsequent ISR without excessive stent overhang. Īny more than the desired minimal stent protrusion, may result in future complications and the excessive stent overhang may make Conclusion Current practice advocates treating aorto-ostial stenoses with a short stent overhang, usually 1–2 mm into the aorta, to ensure that the entire ostial disease has been treated, ideally through the use of IVUS to enable accurate stent placement and sizing. PCI for aorto-ostial stenoses of the RCA is prone to complications including high rates of ISR. Six months prior to this presentation, she had suffered an acute coronary syndrome (ACS) and had undergone coronary and graft angiography, which had Discussion We highlight the potential practical challenges of performing PCI for ostial RCA ISR with excessive stent protrusion and describe a novel GuideLiner extension catheter-facilitated side-strut stenting technique with a successful angiographic result and sustained good long-term clinical outcome.Ī 45-year-old female with previous coronary artery bypass grafting (CABG) involving the implantation of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and a saphenous vein graft (SVG) to the intermediate artery (ICA) and the right coronary artery (RCA) was admitted to our centre with crescendo angina. Although the treatment of restenosis through PCI using stent struts has been described previously, this may result in device entrapment or even stent dislodgement, ,,. Conversely, stent placement with excessive aortic overhang may prevent subsequent guiding catheter engagement and/or guidewire access through the stented lumen, making subsequent interventions for ostial ISR or distal de-novo disease difficult or impossible. The non-tubular anatomy of the RCA ostium makes it prone to geographic miss which is reported in up to 54% of cases and results in a three-fold increase in restenosis and the need for repeat intervention. Flaring of the ostial portion of the stent has been used to enable future guiding catheter access for repeat intervention. The use of intravascular ultrasound (IVUS) is recommended to improve better long term-outcomes. ĭuring PCI, accurate stent placement with minimal stent protrusion into the aorta is desirable to ensure adequate ostial coverage and minimise late complications. Most of this recoil is due to the highly elastic composition and non-tubular anatomy of the RCA ostium. This is attributable to excessive elastic recoil after balloon dilation. Percutaneous coronary intervention (PCI) for right coronary artery (RCA) ostial stenoses is technically challenging and associated with higher incidence of in-stent restenosis (ISR).