OCT guidance for evaluation and treatment of the long-term consequences of inadequate ostial left circumflex stenting

The optimal treatment of coronary lesions affecting circumflex (CX) or left anterior descending (LAD) ostia remains a subject of debate, as stent implantation is associated with competing risks of inadequate plaque coverage and excessive stent protrusion into the left main (LM)1.

We show an example of ostial CX stent implantation in a 54-year-old male patient presenting with acute coronary syndrome (Figure 1A, Figure 1B, Moving image 1A, Moving image 1B). After 1 year, the patient presented with chest pain. Regional wall motion abnormalities were reported on a stress echocardiogram, mainly of the septum and of the lateral wall of the left ventricle. Subsequent angiography showed a hazy stenosis at the level of the ostial LAD (Figure 1C, Moving image 2), which corresponded to tissue-covered stent struts protruding from the CX on optical coherence tomography (OCT) (Figure 1D, Moving image 3). A wire was passed into the LAD, and its position outside of the protruding CX stent strut contour was confirmed by OCT (Figure 1E), which allowed for the successful execution...