Reassessing single-stent techniques for isolated left anterior descending ostial disease: a two-year intravascular ultrasound-guided retrospective comparison of precise ostial, floating, and crossover stenting strategies

Abstract

Background/objectives: Percutaneous coronary intervention (PCI) for isolated left anterior descending (LAD) ostial lesions remains challenging, with limited comparative data on stenting strategies. We aimed to evaluate the procedural and long-term outcomes of three single-stent techniques: precise ostial stenting (POS), floating stenting (FS), and crossover stenting (CS).

Methods: In this retrospective study, 116 patients with isolated LAD ostial disease underwent intravascular ultrasound (IVUS)-guided PCI using one of the three strategies. Baseline characteristics, procedural details, IVUS findings, and major adverse cardiac and cerebrovascular events (MACCEs) over two years were compared.

Results: Compared to POS and FS, CS resulted in larger minimal stent area at the ostium, and a higher rate of complete stent coverage (100% vs. 39.5% and 23.1%, p < 0.001). At 2-year follow-up, MACCE rates were significantly lower in the CS group (2.6%) compared to FS (13.5%) and POS (15.8%, p = 0.039), mainly due to reduced target lesion revascularization. FS showed improved coverage compared to POS, but inferior angiographic outcomes and higher event rates than CS.

Conclusions: In IVUS-guided PCI for isolated LAD ostial lesions, CS offers superior ostial coverage and clinical outcomes. FS may serve as a compromise when anatomical constraints limit crossover. These findings support a tailored strategy based on lesion characteristics and IVUS assessment.

Keywords: Crossover stenting; Floating stent; Intravascular ultrasound; Ostial left anterior descending lesion; Percutaneous coronary intervention.

Fig. 1

Study Flow. POS, precise ostial stenting; FS, floating stenting; CS, crossover stenting; PCI, percutaneous coronary intervention; IVUS, intravascular ultrasound; LAD, left anterior descending artery; LCX, left circumflex artery

Fig. 2

Schematic comparison of three single-stent techniques for ostial LAD lesions. This figure illustrates three IVUS-guided single-stent techniques for isolated ostial LAD lesions: precise ostial stenting (POS), floating stenting (FS), and crossover stenting (CS). Each panel shows stent position relative to the LMCA and LCX, and whether side-branch protection or optimization techniques were used. POS is deployed precisely at the LAD ostium without entering the LMCA or LCX, but may risk geographic miss. FS covers the ostium with minimal protrusion into the LMCA, balancing simplicity and coverage. CS extends from LMCA into LAD, offering full coverage but often requiring POT or kissing balloon inflation to manage side-branch compromise. Abbreviations: LAD, left anterior descending artery; LMCA, left main coronary artery; LCX, left circumflex artery; POT, proximal optimization technique; IVUS, intravascular ultrasound; FS, floating stenting; POS, precise ostial stenting; CS, crossover stenting; KBI. kissing balloon inflation; MSA, minimum stent area

Fig. 3

Kaplan–Meier Curves for MACCE Among the Three Groups. Kaplan–Meier analysis of cumulative MACCE during 2-year follow-up. The POS group exhibited a significantly higher incidence of MACCE compared to the FS and CS groups (log-rank P < 0.001). The CS group demonstrated the most favorable event-free survival, while the FS group showed intermediate outcomes. POS, precise ostial stenting; FS, floating stenting; CS, crossover stenting; MACCE, major adverse cardiovascular and cerebrovascular events